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GUIDE

The PRISMA 2020 flow diagram, explained box by box

What each number means, where reviewers look for mistakes, and how to make the arithmetic balance.

1. Identification

Records identified from databases and registers, plus records from other methods (websites, organisations, citation searching). Report each database count separately in the text; the diagram shows the total. Duplicates removed are subtracted here, before screening.

2. Screening

Records screened is the count after de-duplication. Records excluded here are those rejected on title and abstract. Then: reports sought for retrieval, reports not retrieved, reports assessed for eligibility, and reports excluded with reasons (each reason with its own count).

3. Included

Studies included in the review and, separately, reports of those studies. One study may have several reports; make sure both numbers appear and that the relationship is explained in the text.

4. The arithmetic that must balance

Identified − duplicates = screened. Screened − excluded = sought for retrieval. Sought − not retrieved = assessed. Assessed − excluded with reasons = included. PaperPict's PRISMA tool checks each of these equations and flags a mismatch before you export.

5. Common reviewer complaints

Missing the 'reports not retrieved' box, listing exclusion reasons without counts, mixing studies and reports, and using the 2009 template after 2021. Use the 2020 layout with the 'other methods' column when applicable.

6. Formatting

Boxes with a thin border, arrows with a single head, and a sans-serif face. Export as a vector (SVG or PDF) so it stays sharp in the supplementary material and in the published article.

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