Systematic review

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Clinical trials should begin and end with systematic reviews of relevant evidence

— Mike Clarke, Sally Hopewell, Iain Chalmers, 2016, PMID 20609983

All health researchers should begin their training by preparing at least one systematic review

— Kamal R Mahtani, 2016, PMID 27118697


A systematic review is a literature review focused on a single question which tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews are generally regarded as the highest level of medical evidence by evidence-based medicine professionals. An understanding of systematic reviews and how to implement them in practice is becoming mandatory for all professionals involved in the delivery of health care.

Reporting standards


In 1987, Mulrow assessed review articles for the following criteria[1]:

  1. Was the specific purpose of the review stated?
  2. Were sources and methods of the citation search identified?
  3. Inclusion criteria: "Were explicit guidelines provided that determined the material included in and excluded from the review"?
  4. Validity assessment of included articles: "Was a methodologic validity assessment of material in the review performed"?
  5. Was the information systematically integrated with explication of data limitations and inconsistencies?
  6. Was the information integrated and weighted or pooled metrically?
  7. Was a summary of pertinent findings provided?
  8. Were specific directives for new research initiatives proposed?


The history of the QUORUM and PRISMA reporting standards are summarized[2].

  • QUORUM (QUality Of Reporting Of Meta-analyses) was started in 1999 to recommend reporting standards for meta-analyses of randomized controlled trials.
  • PRISMA (Preferred Reporting Items of Systematic reviews and Meta-Analyses) was started in 2009


A systematic review is a summary of healthcare research that uses explicit methods to perform a thorough literature search and critical appraisal of individual studies to identify the valid and applicable evidence. It often, but not always, uses appropriate techniques (meta-analysis) to combine these valid studies, or at least uses grading of the levels of evidence depending on the methodology used.

While many systematic reviews are based on an explicit quantitative meta-analysis of available data, there are also qualitative reviews which nonetheless adhere to the standards for gathering, analyzing and reporting evidence.

Living systematic reviews

Living systematic reviews have been described:

Cochrane collaboration

Many healthcare journals now publish systematic reviews, but the best-known source is the Cochrane Collaboration, a group of over 6,000 specialists in health care who systematically review randomised trials of the effects of treatments and, when appropriate, the results of other research. Cochrane reviews are published in the Cochrane Database of Systematic Reviews section of the Cochrane Library, which to date (February 2007) contains 2,893 complete reviews and 1,646 protocols.

The Cochrane Group provides a handbook for systematic reviewers of interventions, where they suggest that each systematic review should contain the following main sections:

  • Background
  • Objectives
  • Methods of the review
  • Results
  • Conclusion and discussion

There are seven steps for preparing and maintaining a systematic review, as outlined in the Cochrane Handbook:

  1. Formulating a problem
  2. Locating and selecting studies
  3. Critical appraisal of studies
  4. Collecting data
  5. Analyzing and presenting results
  6. Interpreting results
  7. Improving and updating reviews

Strengths and weaknesses

While systematic reviews are regarded as the strongest form of medical evidence, a review of 300 studies found that not all systematic reviews were equally reliable, and that their reporting could be improved by a universally agreed upon set of standards and guidelines.[3]

A further study by the same group found that of 100 guidelines reviewed, 4% required updating within a year, and 11% after 2 years; this figure was higher in rapidly-changing fields of medicine, especially cardiovascular medicine.[4] 7% of systematic reviews needed updating at the time of publication. [4]

Teaching how to conduct systematic reviews may help teach research skills[5].

See also


  1. Mulrow CD (1987). "The medical review article: state of the science". Ann Intern Med. 106 (3): 485–8. doi:10.7326/0003-4819-106-3-485. PMID 3813259.
  2. Anonymous. History & Development of PRISMA. Available at
  3. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG (2007). "Epidemiology and reporting characteristics of systematic reviews". PLoS Med. 4 (3): e78. doi:10.1371/journal.pmed.0040078. PMID 17388659.
  4. 4.0 4.1 Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, Moher D (2007). "How quickly do systematic reviews go out of date? A survival analysis". Ann. Intern. Med. 147 (4): 224–33. PMID 17638714.
  5. Himelhoch S, Edwards S, Ehrenreich M, Luber MP (September 2015). "Teaching Lifelong Research Skills in Residency: Implementation and Outcome of a Systematic Review and Meta-Analysis Course". J Grad Med Educ. 7 (3): 445–50. doi:10.4300/JGME-D-14-00505.1. PMC 4597958. PMID 26457153.

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