Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram
Open accessAbstract
Cochrane systematic reviews are conducted and reported according to rigorous standards. A study flow diagram must be included in a new review, and there is clear guidance from the PRISMA statement on how to do this. However, for a review update, there is currently no guidance on how study flow diagrams should be presented. To address this, a working group was formed to find a solution and produce guidance on how to use these diagrams in review updates.A number of different options were devised for how these flow diagrams could be used in review updates, and also in cases where multiple searches for a review or review update have been conducted. These options were circulated to the Cochrane information specialist community for consultation and feedback. Following the consultation period, the working group refined the guidance and made the recommendation that for review updates an adapted PRISMA flow diagram should be used, which includes an additional box with the number of previously included studies feeding into the total. Where multiple searches have been conducted, the results should be added together and treated as one set of results.There is no existing guidance for using study flow diagrams in review updates. Our adapted diagram is a simple and pragmatic solution for showing the flow of studies in review updates.
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The PRISMA 2020 flow diagram design is adapted from flow diagrams proposed by Boers, Mayo-Wilson et al., and Stovold et al.
“The new design is adapted from flow diagrams proposed by Boers [55], Mayo-Wilson et al. [56] and Stovold et al. [57]”
From The PRISMA 2020 statement: an updated guideline for reporting systematic reviews (2021) · cites this paper as [57]
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- Authors
- Stovold, E., Beecher, D., Foxlee, R., & Noel-Storr, A.
- Affiliations
- St George's, University of London (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Cochrane (GB)
- John Radcliffe Hospital (GB)
- Corresponding author
- Stovold, Elizabeth
- Venue
- Systematic Reviews
- Published
- 2014-05-29
- Volume
- 3
- Issue
- 1
- Pages
- 54-54
- ISSN
- 2046-4053 (ISSN-L)
- PMC
- PMC4046496
- OpenAlex
- W2096266245
- Cited by
- 356
- References
- 7
- Citations by year
- 2026: 25 · 2025: 47 · 2024: 46 · 2023: 46 · 2022: 53 · 2021: 41 · 2020: 24 · 2019: 14 · 2018: 15 · 2017: 17 · 2016: 15 · 2015: 10 · 2014: 1 · 2013: 2
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Systematic Reviews (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- study flow diagram, PRISMA, reporting guidelines
- MeSH terms
- Data Display, Humans, Publishing, Review Literature as Topic, Guidelines as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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