The PRISMA 2020 checklist contains 27 items that researchers must address when reporting a systematic review or meta-analysis. Published alongside the PRISMA 2020 statement by Page et al. (2021), this checklist replaces the original 2009 version with substantially revised items that reflect advances in systematic review methodology, including enhanced requirements for search transparency, risk of bias assessment, and certainty of evidence evaluation.
This guide explains every item in the PRISMA 2020 checklist, organized by section, so you can ensure your systematic review manuscript meets current reporting standards. To work through the items and track your progress as you write, use our interactive PRISMA checklist tool.
Title (Item 1)
Item 1: Title. Identify the report as a systematic review.
Your title should explicitly include the words "systematic review" and, if applicable, "meta-analysis." The title should also indicate the specific topic, population, intervention, and outcomes when possible. This helps readers and databases correctly classify your report.
Abstract (Item 2)
Item 2: Abstract. Provide a structured summary including background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, limitations, conclusions, and systematic review registration number.
PRISMA 2020 recommends following the structured abstract format used by your target journal. The abstract should be a standalone summary that allows readers to assess the review's scope and findings without reading the full text.
Introduction (Items 3-4)
Item 3: Rationale. Describe the rationale for the review in the context of existing knowledge.
Explain why the review was needed, referencing existing reviews and gaps in the evidence. Describe the conceptual or theoretical framework underlying the review question.
Item 4: Objectives. Provide an explicit statement of the questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).
State your research question clearly using the PICO(S) framework. If you registered a protocol, reference it here. For guidance on protocol development, see our guide on writing a systematic review protocol using PRISMA-P.
Methods (Items 5-15)
Item 5: Eligibility Criteria
Report the inclusion and exclusion criteria for studies, including characteristics of participants, interventions, comparisons, outcomes, study design, and setting. Specify the report characteristics used as criteria (e.g., language, publication status, date range).
Item 6: Information Sources
Describe all information sources searched, including databases, registers, websites, organizations, reference lists, and other sources. Report the date of the last search for each source. For detailed guidance on search reporting, see how to report search strategies using PRISMA-S.
Item 7: Search Strategy
Present the full electronic search strategy for at least one database, including any limits used, so that it could be repeated. PRISMA 2020 recommends presenting search strategies for all databases, ideally in a supplementary file.
Item 8: Selection Process
Specify the methods used to decide whether a study met the inclusion criteria, including how many reviewers screened each record, whether they worked independently, and the consensus process for disagreements.
Item 9: Data Collection Process
Specify the methods used to collect data from reports, including how many reviewers collected data, whether they worked independently, any processes for obtaining or confirming data from study investigators, and any automation tools used.
Item 10: Data Items
List and define all outcomes for which data were sought, specifying whether all results consistent with each outcome domain were sought, and any methods for handling missing summary statistics.
Item 11: Study Risk of Bias Assessment
Specify the methods used to assess risk of bias in included studies, including the tool(s) used, how many reviewers assessed each study, and whether they worked independently. The correct instrument depends on the study designs you included: a randomised-trial tool does not fit observational data, so naming and justifying the tool matters as much as applying it. Our guide to choosing a risk of bias tool matched to your study designs maps common instruments to the designs they were validated for, which is the detail Item 11 expects you to report.
Item 12: Effect Measures
Specify for each outcome the effect measure(s) used in the synthesis or presentation of results.
Item 13: Synthesis Methods
Describe the processes used to decide which studies were eligible for each synthesis, any methods required to prepare data for synthesis, the methods used to tabulate or visually display results, methods used to synthesize results, any methods used to explore possible causes of heterogeneity, and any sensitivity analyses conducted.
Item 14: Reporting Bias Assessment
Describe any methods used to assess the risk of bias due to missing results in a synthesis (publication bias).
Item 15: Certainty Assessment
Describe any methods used to assess certainty in the body of evidence for an outcome, such as the GRADE approach.
Results (Items 16-22)
Item 16: Study Selection
Describe the results of the search and selection process, ideally with a PRISMA 2020 flow diagram, and cite studies that appeared to meet the inclusion criteria but were excluded, with the reasons. Give the total number of records identified, records excluded, reports retrieved, and studies included at each stage. You can create your flow diagram using our free tool to generate PRISMA 2020 flow diagrams.
Item 17: Study Characteristics
Cite each included study and present its characteristics relevant to the review question.
Item 18: Risk of Bias in Studies
Present assessments of risk of bias for each included study.
Item 19: Results of Individual Studies
For all outcomes, present for each study summary statistics and effect estimates with confidence intervals, ideally in a structured table or forest plot.
Item 20: Results of Syntheses
For each synthesis, briefly summarize the characteristics and risk of bias among contributing studies, present the results of the synthesis, investigate possible causes of heterogeneity, and present any sensitivity analyses.
Item 21: Reporting Biases
Present assessments of the risk of bias due to missing results for each synthesis.
Item 22: Certainty of Evidence
Present assessments of certainty in the body of evidence for each outcome assessed.
Discussion (Item 23)
Item 23: Discussion
Provide a general interpretation of the results in the context of other evidence, discuss limitations of the evidence and the review process, and discuss implications for practice, policy, and future research.
Other Information (Items 24-27)
Item 24: Registration and Protocol
Provide registration information including the register name and registration number, or state that the review was not registered. State where the review protocol can be accessed, or that one was not prepared, and note any amendments to the information provided at registration or in the protocol.
Item 25: Support
Describe sources of financial or non-financial support for the review and the role of the funders or sponsors.
Item 26: Competing Interests
Declare any competing interests of the review authors.
Item 27: Availability of Data, Code and Other Materials
Report which of the following are publicly available and where: template data collection forms, extracted data, data used in analyses, analytic code, and any other materials used in the review.
Key Differences from the 2009 Checklist
The PRISMA 2020 checklist substantially revises the original items. Key enhancements include more granular methods reporting, explicit requirements for risk of bias and certainty assessments, and better alignment with current systematic review best practices. For a detailed comparison, see PRISMA 2020 vs original PRISMA: what changed.
Frequently Asked Questions
How many items are in the PRISMA 2020 checklist?
The PRISMA 2020 checklist contains 27 items, the same number as the original 2009 version. However, many items have been substantially revised, split into sub-items, or expanded to provide greater specificity in reporting requirements.
Do I need to address every item in the checklist?
Yes, you should address every applicable item. If an item is not applicable to your review (e.g., certainty assessment if not conducted), explicitly state that it was not performed and explain why.
Where should I submit the completed checklist?
Most journals require you to submit a completed PRISMA 2020 checklist as a supplementary file alongside your manuscript. Indicate the page or section number where each item is addressed.
Is the PRISMA 2020 checklist different from PRISMA-P?
Yes. PRISMA-P is a separate checklist for systematic review protocols, while PRISMA 2020 is for the completed review. They are complementary: PRISMA-P guides protocol writing, and PRISMA 2020 guides the final manuscript.