Nursing Resources

Library Resources for the UVA School of Nursing

PRISMA Article Flow Diagram Instructions


Step 1: Preparation To complete the the PRISMA diagram print out a copy of the diagram to use alongside your searches. A downloadable template of the diagram is available on my SON page in the Primary Research Tools box.  In addition, there is another PRISMA diagram template that I designed for use as a standalone note in Zotero.

Step 2: Doing the database search Search all databases using your search stategy. Combine all the search terms using boolean operators like AND or OR as appropriate. Export all citations from each database to the same folder in Zotero.  Record the total number of citations and enter the number in the top left box of the PRISMA flow chart.

PRISMA additional sources


Step 3: Additional sources If you have identified articles through other sources than databases (like manual searches through reference lists of articles you have found or Search engines like Google Scholar), enter the total number of records in the box on the top right of the flow diagram.

PRISMA diagram showing duplicates removed box


Step 4: Remove all duplicates Use Zotero to remove all duplicates. Enter the number of records left after you have removed the duplicate in the second box from the top.

PRISMA records screened


Step 5: Screening articles The next step is to add in the number of articles that you have screened. This is the same number as you have entered in the duplicates removed box.

PRISMA records excluded box


Step 6: Screening - Excluded articles You will now need to screen the titles and abstracts for articles which are relevant to your research question. You may want to consider using a tagging system in Zotero to keep track of your actions.  For example, you can create tags for INCLUDE and EXCLUDE and assign them a color.  Any articles that appear to help you provide an answer to your research question should be included. Record the number of articles excluded based on this screening process in the appropriate box (next to the total number of screened records). 

PRISMA eligability box


Step 7: Eligibility Subtract the number of excluded articles following the screening phase (step 6) from the total number of records screened (step 5) and enter this number in the box titled "Full-text articles assessed for eligibility". Get the full text for these articles to review for eligibility.  Use the library's free interlibrary loan service to obtain articles not in the UVA collection.

PRISMA full text articles excluded


Step 8: Eligibility - Records excluded Review all full-text articles for eligibility to be included in the final review. Take a note of the number of articles that you exclude at this point and enter this number in the correct box titled: Full text articles excluded, and then write in a short reason for excluding the articles (this may be the same reason used for the screening phase).  Examples include wrong setting, wrong patient population, wrong intervention, wrong dosage, etc.

PRISMA articles excluded


Step 9: Included The final step is to subtract the number of excluded articles or records during the eligibility review of full-text (step 8) from the total number of articles reviewed for eligibility (step 7). Enter this number in the last box.  You have now completed your PRISMA flow diagram which you can now include in the results section of your article or assignment.

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