The evolution, application, and challenges of the PRISMA reporting guideline framework_Chinese Journal of Evidence-Based Medicine

Authors：

ZHENG Qingyong ^1,2,3 , XU Jianguo ^1,2,3 , ZHOU Ziyu ⁴ , XU Haitao ⁵ , ZHANG Mengjun ⁶ , TIAN Chen ^2,7,8,9 , LIU Hui ^1,2,3 , YAO Yuanyuan ^1,2,3 , LIU Ming ^1,2,10 , GAO Ya ^11,12 , GE Long ^2,7,8,9 ,  TIAN Jinhui ^1,2,3 ,  ZHANG Junhua ^13,14

1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
2. Key Laboratory of Evidence-Based Medicine of Gansu Province, Lanzhou 730000, P. R. China;
3. Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, Lanzhou 730000, P. R. China;
4. The Second Clinical Medical School, Lanzhou University, Lanzhou 730030, P. R. China;
5. College of Artificial Intelligence Medicine, Chongqing Medical University, Chongqing 400016, P. R. China;
6. School of Nursing, Hebei University, Baoding 071000, P. R. China;
7. Department of Health Policy and Management, School of Public Health, Lanzhou 730000, P. R. China;
8. Laboratory of Cross-Innovation for Evidence-based Social Sciences, Lanzhou 730000, P. R. China;
9. Research Centre for Health Management and Health Development, Lanzhou University, Lanzhou 730000, P. R. China;
10. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639646, Singapore;
11. School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, P. R. China;
12. National Institute of Health and Medical Data Science, Jinan 250003, P. R. China;
13. Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;
14. Key Laboratory of Evidence-Based Evaluation of Traditional Chinese Medicine, National Medical Products Administration, Tianjin 301617, P. R. China;

Corresponding author：

TIAN Jinhui, Email: tjh996@163.com; ZHANG Junhua, Email: zjhtcm@163.com

Keywords：

PRISMA statement; Systematic review; Meta-analysis; Reporting guideline; Evidence-based medicine; Challenge

DOI：

10.7507/1672-2531.202504084

Video：

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Abstract Full text Figures/Tables Video References Cited by

The reporting quality of systematic reviews and meta-analyses is fundamental to the value of evidence in evidence-based medicine. As the internationally endorsed standard, the PRISMA statement and its extensive suite of extensions are crucial for standardizing reporting and enhancing transparency. However, a comprehensive, systematic understanding of its entire framework and profound challenges remains inadequate in the academic community. This review aims to systematically delineate and deeply analyze the complete PRISMA reporting guideline framework, evaluate its application value, uncover its implementation challenges, and forecast its future development directions. This paper traces PRISMA's evolution from its predecessor, QUOROM, to PRISMA 2020, highlighting key shifts in its core principles. It systematically constructs a multi-dimensional framework for the PRISMA family for the first time, categorizing its extensions by foundational versions, study design/analysis types, reporting process stages, disciplinary domains, and specific areas of focus, complemented by a forward-looking analysis of tools currently under development. The review delves into the deep-seated challenges in PRISMA's implementation, including misconceptions, inconsistent application, cross-disciplinary adaptability, and methodological limitations. It proposes that its future lies in balancing standardization with flexibility, enhancing globalized application, and deeply integrating with emerging technologies like artificial intelligence. The PRISMA framework has evolved from a mere reporting checklist into a core methodological architecture that promotes standardization throughout the entire evidence synthesis lifecycle. The continuous optimization and proper application of this framework are of critical theoretical and practical significance for enhancing the overall quality and impact of evidence synthesis research globally.

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2.	张俊华, 孙鑫, 李幼平, 等. 循证中医药学的现在和未来. 中国循证医学杂志, 2019, 19(5): 515-520.
3.	靳英辉, 吴世文, 拜争刚, 等. 系统评价与Meta分析的内涵及价值. 同济大学学报(医学版), 2019, 40(1): 105-111.
4.	Lund H, Brunnhuber K, Juhl C, et al. Towards evidence based research. BMJ, 2016, 355: i5440.
5.	翁鸿, 任学群, 王行环, 等. 临床研究的选题原则及选题. 中国循证心血管医学杂志, 2017, 9(3): 257-260.
6.	McGrath TA, Alabousi M, Skidmore B, et al. Recommendations for reporting of systematic reviews and meta-analyses of diagnostic test accuracy: a systematic review. Syst Rev, 2017, 6(1): 194.
7.	Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
8.	高亚, 刘明, 杨珂璐, 等. 系统评价报告规范: PRISMA 2020与PRISMA 2009的对比分析与实例解读. 中国循证医学杂志, 2021, 21(5): 606-616.
9.	Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 2021, 372: n160.
10.	Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
11.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
12.	Moher D, Liberati A, Tetzlaff J, 等. 系统综述和荟萃分析优先报告的条目: PRISMA声明. 中西医结合学报, 2009, 7(9): 889-896.
13.	Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 2015, 162(11): 777-784.
14.	Stewart LA, Clarke M, Rovers M, et al. Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA, 2015, 313(16): 1657-1665.
15.	McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA, 2018, 319(4): 388-396.
16.	Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med, 2018, 169(7): 467-473.
17.	Akl EA, Khabsa J, Iannizzi C, et al. Extension of the PRISMA 2020 statement for living systematic reviews (PRISMA-LSR): checklist and explanation. BMJ, 2024, 387: e079183.
18.	Elsman EBM, Mokkink LB, Terwee CB, et al. Guideline for reporting systematic reviews of outcome measurement instruments (OMIs): PRISMA-COSMIN for OMIs 2024. J Clin Epidemiol, 2024, 173: 111422.
19.	Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015, 4(1): 1.
20.	Beller EM, Glasziou PP, Altman DG, et al. PRISMA for Abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Med, 2013, 10(4): e1001419.
21.	Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev, 2021, 10(1): 39.
22.	Cohen JF, Deeks JJ, Hooft L, et al. Preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts): checklist, explanation, and elaboration. BMJ, 2021, 372: n265.
23.	Wang X, Chen Y, Liu Y, et al. Reporting items for systematic reviews and meta-analyses of acupuncture: the PRISMA for acupuncture checklist. BMC Complement Altern Med, 2019, 19(1): 208.
24.	Zhang X, Tan R, Lam WC, et al. PRISMA (preferred reporting items for systematic reviews and meta-analyses) extension for Chinese herbal medicines 2020 (PRISMA-CHM 2020). Am J Chin Med, 2020, 48(6): 1279-1313.
25.	Zhang X, Tan R, Lam WC, et al. PRISMA extension for moxibustion 2020: recommendations, explanation, and elaboration. Syst Rev, 2020, 9(1): 247.
26.	Zhao B, Hu K, Zeng X, et al. Development of a reporting guideline for systematic reviews of animal experiments in the field of traditional Chinese medicine. J Evid Based Med, 2022, 15(2): 152-167.
27.	O'Dea RE, Lagisz M, Jennions MD, et al. Preferred reporting items for systematic reviews and meta-analyses in ecology and evolutionary biology: a PRISMA extension. Biol Rev Camb Philos Soc, 2021, 96(5): 1695-1722.
28.	Welch V, Petticrew M, Tugwell P, et al. PRISMA-Equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med, 2012, 9(10): e1001333.
29.	Zorzela L, Loke YK, Ioannidis JP, et al. PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ, 2016, 352: i157.
30.	Guise JM, Butler ME, Chang C, et al. AHRQ series on complex intervention systematic reviews-paper 6: PRISMA-CI extension statement and checklist. J Clin Epidemiol, 2017, 90: 43-50.
31.	Zheng Q, Xu J, Gao Y, et al. Past, present and future of living systematic review: a bibliometrics analysis. BMJ Glob Health, 2022, 7(10): e009378.
32.	郑卿勇, 程露颖, 许建国, 等. 动态系统评价的研究现状与进展. 中国药物评价, 2021, 38(6): 471-478.
33.	Li T, Hua F, Dan S, et al. Reporting quality of systematic review abstracts in operative dentistry: an assessment using the PRISMA for Abstracts guidelines. J Dent, 2020, 102: 103471.
34.	Peters JP, Hooft L, Grolman W, et al. Reporting quality of systematic reviews and meta-analyses of otorhinolaryngologic articles based on the PRISMA statement. PLoS One, 2015, 10(8): e0136540.
35.	Sarkis-Onofre R, Catalá-López F, Aromataris E, et al. How to properly use the PRISMA Statement. Syst Rev, 2021, 10(1): 117.
36.	Fatalla AA, Arzani S, Veseli E, et al. Revolutionizing systematic reviews and meta-analyses: the role of artificial intelligence in evidence synthesis. Dental Hypotheses, 2023, 14(4): 93-94.
37.	Stern C, Lizarondo L, Carrier J, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Implement, 2021, 19(2): 120-129.
38.	赖鸿皓, 王浙, 李滢, 等. 中医药多元证据整合方法学MERGE框架. 协和医学杂志, 2024, 15(1): 172-182.
39.	Östlund U, Kidd L, Wengström Y, et al. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud, 2011, 48(3): 369-383.
40.	Sylvestre E, Joachim C, Cécilia-Joseph E, et al. Data-driven methods for dengue prediction and surveillance using real-world and Big Data: a systematic review. PLoS Negl Trop Dis, 2022, 16(1): e0010056.
41.	Vollert J, Kleykamp BA, Farrar JT, et al. Real-world data and evidence in pain research: a qualitative systematic review of methods in current practice. Pain Rep, 2023, 8(2): e1057.
42.	Bendersky J, Auladell-Rispau A, Urrútia G, et al. Methods for developing and reporting living evidence synthesis. J Clin Epidemiol, 2022, 152: 89-100.
43.	Pandey NM, Tripathi RK, Kar SK, et al. Mental health promotion for elderly populations in World Health Organization South-East Asia Region: needs and resource gaps. World J Psychiatry, 2022, 12(1): 117-127.
44.	Min B, Ross H, Sulem E, et al. Recent advances in natural language processing via large pre-trained language models: a survey. ACM Comput Surv, 2023, 56(2): 36.

1. Subbiah V. The next generation of evidence-based medicine. Nat Med, 2023, 29(1): 49-58.
2. 张俊华, 孙鑫, 李幼平, 等. 循证中医药学的现在和未来. 中国循证医学杂志, 2019, 19(5): 515-520.
3. 靳英辉, 吴世文, 拜争刚, 等. 系统评价与Meta分析的内涵及价值. 同济大学学报(医学版), 2019, 40(1): 105-111.
4. Lund H, Brunnhuber K, Juhl C, et al. Towards evidence based research. BMJ, 2016, 355: i5440.
5. 翁鸿, 任学群, 王行环, 等. 临床研究的选题原则及选题. 中国循证心血管医学杂志, 2017, 9(3): 257-260.
6. McGrath TA, Alabousi M, Skidmore B, et al. Recommendations for reporting of systematic reviews and meta-analyses of diagnostic test accuracy: a systematic review. Syst Rev, 2017, 6(1): 194.
7. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372: n71.
8. 高亚, 刘明, 杨珂璐, 等. 系统评价报告规范: PRISMA 2020与PRISMA 2009的对比分析与实例解读. 中国循证医学杂志, 2021, 21(5): 606-616.
9. Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 2021, 372: n160.
10. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354(9193): 1896-1900.
11. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
12. Moher D, Liberati A, Tetzlaff J, 等. 系统综述和荟萃分析优先报告的条目: PRISMA声明. 中西医结合学报, 2009, 7(9): 889-896.
13. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med, 2015, 162(11): 777-784.
14. Stewart LA, Clarke M, Rovers M, et al. Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA, 2015, 313(16): 1657-1665.
15. McInnes MDF, Moher D, Thombs BD, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA, 2018, 319(4): 388-396.
16. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med, 2018, 169(7): 467-473.
17. Akl EA, Khabsa J, Iannizzi C, et al. Extension of the PRISMA 2020 statement for living systematic reviews (PRISMA-LSR): checklist and explanation. BMJ, 2024, 387: e079183.
18. Elsman EBM, Mokkink LB, Terwee CB, et al. Guideline for reporting systematic reviews of outcome measurement instruments (OMIs): PRISMA-COSMIN for OMIs 2024. J Clin Epidemiol, 2024, 173: 111422.
19. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015, 4(1): 1.
20. Beller EM, Glasziou PP, Altman DG, et al. PRISMA for Abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Med, 2013, 10(4): e1001419.
21. Rethlefsen ML, Kirtley S, Waffenschmidt S, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev, 2021, 10(1): 39.
22. Cohen JF, Deeks JJ, Hooft L, et al. Preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for Abstracts): checklist, explanation, and elaboration. BMJ, 2021, 372: n265.
23. Wang X, Chen Y, Liu Y, et al. Reporting items for systematic reviews and meta-analyses of acupuncture: the PRISMA for acupuncture checklist. BMC Complement Altern Med, 2019, 19(1): 208.
24. Zhang X, Tan R, Lam WC, et al. PRISMA (preferred reporting items for systematic reviews and meta-analyses) extension for Chinese herbal medicines 2020 (PRISMA-CHM 2020). Am J Chin Med, 2020, 48(6): 1279-1313.
25. Zhang X, Tan R, Lam WC, et al. PRISMA extension for moxibustion 2020: recommendations, explanation, and elaboration. Syst Rev, 2020, 9(1): 247.
26. Zhao B, Hu K, Zeng X, et al. Development of a reporting guideline for systematic reviews of animal experiments in the field of traditional Chinese medicine. J Evid Based Med, 2022, 15(2): 152-167.
27. O'Dea RE, Lagisz M, Jennions MD, et al. Preferred reporting items for systematic reviews and meta-analyses in ecology and evolutionary biology: a PRISMA extension. Biol Rev Camb Philos Soc, 2021, 96(5): 1695-1722.
28. Welch V, Petticrew M, Tugwell P, et al. PRISMA-Equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med, 2012, 9(10): e1001333.
29. Zorzela L, Loke YK, Ioannidis JP, et al. PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ, 2016, 352: i157.
30. Guise JM, Butler ME, Chang C, et al. AHRQ series on complex intervention systematic reviews-paper 6: PRISMA-CI extension statement and checklist. J Clin Epidemiol, 2017, 90: 43-50.
31. Zheng Q, Xu J, Gao Y, et al. Past, present and future of living systematic review: a bibliometrics analysis. BMJ Glob Health, 2022, 7(10): e009378.
32. 郑卿勇, 程露颖, 许建国, 等. 动态系统评价的研究现状与进展. 中国药物评价, 2021, 38(6): 471-478.
33. Li T, Hua F, Dan S, et al. Reporting quality of systematic review abstracts in operative dentistry: an assessment using the PRISMA for Abstracts guidelines. J Dent, 2020, 102: 103471.
34. Peters JP, Hooft L, Grolman W, et al. Reporting quality of systematic reviews and meta-analyses of otorhinolaryngologic articles based on the PRISMA statement. PLoS One, 2015, 10(8): e0136540.
35. Sarkis-Onofre R, Catalá-López F, Aromataris E, et al. How to properly use the PRISMA Statement. Syst Rev, 2021, 10(1): 117.
36. Fatalla AA, Arzani S, Veseli E, et al. Revolutionizing systematic reviews and meta-analyses: the role of artificial intelligence in evidence synthesis. Dental Hypotheses, 2023, 14(4): 93-94.
37. Stern C, Lizarondo L, Carrier J, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Implement, 2021, 19(2): 120-129.
38. 赖鸿皓, 王浙, 李滢, 等. 中医药多元证据整合方法学MERGE框架. 协和医学杂志, 2024, 15(1): 172-182.
39. Östlund U, Kidd L, Wengström Y, et al. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud, 2011, 48(3): 369-383.
40. Sylvestre E, Joachim C, Cécilia-Joseph E, et al. Data-driven methods for dengue prediction and surveillance using real-world and Big Data: a systematic review. PLoS Negl Trop Dis, 2022, 16(1): e0010056.
41. Vollert J, Kleykamp BA, Farrar JT, et al. Real-world data and evidence in pain research: a qualitative systematic review of methods in current practice. Pain Rep, 2023, 8(2): e1057.
42. Bendersky J, Auladell-Rispau A, Urrútia G, et al. Methods for developing and reporting living evidence synthesis. J Clin Epidemiol, 2022, 152: 89-100.
43. Pandey NM, Tripathi RK, Kar SK, et al. Mental health promotion for elderly populations in World Health Organization South-East Asia Region: needs and resource gaps. World J Psychiatry, 2022, 12(1): 117-127.
44. Min B, Ross H, Sulem E, et al. Recent advances in natural language processing via large pre-trained language models: a survey. ACM Comput Surv, 2023, 56(2): 36.

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