History & Development of PRISMA

Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1,2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers’ ability to assess the strengths and weaknesses of those reviews.

Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].

In 1999, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8].

In 2009, the guideline was updated to address several conceptual and practical advances in the science of systematic reviews, and was renamed PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses). The PRISMA statement was published in multiple journals [9,10,11,12,13,14,15] and accompanied by an Explanation and Elaboration paper [16,17,18,19,20].

To ensure its currency and relevance, in 2017 an international group set out to update the PRISMA 2009 statement by incorporating advances in systematic review methodology and terminology occurring in the last decade. The PRISMA 2020 statement was posted as a preprint on MetaArXiv in September 2020 and published in March 2021. A detailed description of the methods used to update the PRISMA statement is available in Page et al.[21].

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