A Cochrane review reports its study selection using a study flow diagram that follows the same logic as a PRISMA 2020 flow diagram, but with Cochrane's own reporting standards layered on top. Cochrane requires the flow diagram under its MECIR conduct and reporting standards, counts at the level of studies rather than individual references, and traditionally generates the figure inside RevMan, its review management software. Whether you build the diagram in RevMan, in R, or in our free PRISMA 2020 flow diagram generator, the boxes and the top-to-bottom reconciliation are the same; what differs is the surrounding editorial expectation.
Understanding these Cochrane-specific conventions matters because Cochrane reviews are held to an unusually explicit checklist, and an editor will return a figure that does not match the methods section or the characteristics tables.
How a Cochrane Study Flow Differs From a Standalone PRISMA Diagram
The structure is shared, but three Cochrane conventions shape how you fill it in.
First, Cochrane counts studies, not records, at the included stage, and links multiple references to a single study. A trial reported across a protocol, a primary paper, and a secondary analysis is one included study with three references. This study-centred counting flows directly into the "studies included" and "reports of included studies" boxes.
Second, Cochrane reviews are governed by MECIR (Methodological Expectations of Cochrane Intervention Reviews), which makes the flow diagram a mandatory reporting item rather than a nice-to-have. The standards expect the diagram to reconcile with the numbers stated in the text and in the characteristics of included and excluded studies tables.
Third, Cochrane reviews are frequently updates of earlier versions, so the template that distinguishes previously included studies from newly identified ones is often the correct choice. Our overview of the four PRISMA 2020 flow diagram templates explains when to pick the updated-review layout.
MECIR and the Reporting Standards
MECIR separates conduct standards from reporting standards. For the flow diagram, the reporting standards require you to:
- Document the number of records identified from each source.
- Report deduplication and the number screened.
- State how many full texts were assessed and how many were excluded, with reasons recorded in the excluded-studies table.
- Give the number of studies (and their references) included.
Because Cochrane requires an explicit characteristics of excluded studies table, the exclusion reasons in your flow diagram should correspond to the studies you discuss there. This tight coupling between figure and tables is stronger than in many non-Cochrane journals. Our broader walkthrough on how to conduct a systematic review sets these steps in the full review context.
Building the Diagram in RevMan
RevMan can generate a PRISMA-style study flow diagram from the study references you enter, populating the boxes from your screening decisions. The practical tips that save time are:
- Enter your search yield per database before deduplicating, so the identification numbers are defensible.
- Group references under their parent study early, so the included count reflects studies rather than papers.
- Keep the excluded-studies list and its reasons synchronised with the figure as you screen.
If you are drafting outside RevMan or want a quick visual while screening continues, you can enter the same counts into a standalone generator and export a figure, then reconcile it with RevMan before submission. The exact meaning of each count is covered in our explainer on what goes in each PRISMA box.
PRISMA 2020 Alignment
Cochrane has aligned its study flow reporting with PRISMA 2020, so a current Cochrane diagram uses the same phases: identification, screening, eligibility, and inclusion, with a separate "other sources" path when citation searching or handsearching is used. If your review searches trial registries and reference lists in addition to databases, choose the layout that includes the other-sources column so the figure represents the full search.
Counting Studies Across Multiple References
The study-versus-reference distinction is where Cochrane diagrams most often go wrong. Keep two running tallies during screening: one for references (which dominate the top of the diagram) and one for distinct studies (which dominate the bottom). At the included stage you report both: the number of included studies and the number of reports describing them. This mirrors the standard PRISMA distinction but is enforced more strictly in Cochrane because the characteristics tables are organised by study.
Cochrane Reviews and Living Updates
Many Cochrane reviews now run as living reviews with frequent search updates. Each update refreshes the flow diagram, and the updated-review template keeps previously included studies visible alongside newly found ones. Our guide to living systematic reviews explains how to manage the recurring search and screening cycle that feeds these updates.
Frequently Asked Questions
Does a Cochrane review require a PRISMA flow diagram?
Yes. Under the MECIR reporting standards a study flow diagram is expected, and it follows PRISMA 2020 structure. The figure must reconcile with the numbers in the text and the characteristics of included and excluded studies tables.
What is the difference between a study and a reference in a Cochrane diagram?
A reference is a single document, while a study is the underlying research. Cochrane links multiple references to one study, so the included-studies count reflects distinct studies and a separate count reflects the references describing them.
Can I make a Cochrane study flow diagram outside RevMan?
You can draft the figure in R or a web generator using the same counts, which is useful during screening. For the final Cochrane submission, reconcile the figure with RevMan and the characteristics tables so every number matches.
Does Cochrane follow PRISMA 2020?
Yes. Cochrane has aligned its study flow reporting with PRISMA 2020, using the identification, screening, eligibility, and inclusion phases and the separate other-sources path for non-database searching.
How do I report excluded studies in a Cochrane review?
Record exclusion reasons at the full-text stage in the flow diagram, and list the corresponding studies with reasons in the characteristics of excluded studies table. The figure and the table should describe the same exclusions.