Free PRISMA Flow Diagram Generator: PRISMA 2020 Template Online

Why Every Systematic Review Needs a PRISMA Flow Diagram

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram is a mandatory component of systematic review manuscripts. It visually tracks how studies flow through identification, screening, eligibility assessment, and final inclusion.

Without a proper PRISMA flow diagram, your manuscript will be desk-rejected by most medical journals. The EQUATOR Network lists PRISMA as the standard reporting guideline, and editors check for it before sending papers to peer review.

PRISMA 2020 vs. 2009: What Changed?

PRISMA 2020 (Page et al., BMJ 2021) is a major update from the 2009 version. If you're submitting a manuscript in 2024 or later, you must use the 2020 version.

PRISMA 2020 Flow Diagram Template

Here is the standard PRISMA 2020 flow diagram structure. Each box must be filled with the correct count from your systematic review process:

Box-by-Box Filling Guide

Each box in the PRISMA 2020 flow diagram requires specific information. Here's how to fill each one correctly:

How to Create a PRISMA Flow Diagram with MetaReview (Free)

MetaReview is a free online meta-analysis tool that includes a built-in PRISMA 2020 flow diagram generator. Here's how to use it:

PRISMA Flow Diagram Tools Compared

Several tools can create PRISMA flow diagrams. Here's how they compare:

PRISMA 2020 Checklist: 27 Items (6 Most Commonly Missed)

The PRISMA 2020 checklist has 27 items. Items marked OFTEN MISSED are the ones reviewers most frequently flag:

6 Most Common PRISMA-Related Rejection Reasons

Based on editorial feedback patterns across major medical journals, these are the PRISMA issues that most frequently lead to rejection or major revision requests:

1. Using the 2009 template — Most journals now require PRISMA 2020. A 2009-style flow diagram signals outdated methodology to reviewers.
2. Missing full-text exclusion reasons — PRISMA 2020 explicitly requires listing each reason (wrong population, wrong intervention, wrong outcome, wrong design) with individual counts. A single "excluded (n=42)" is insufficient.
3. Numbers don't add up — If "screened" minus "excluded" doesn't equal "full-text assessed," reviewers will immediately request clarification. This often indicates errors in the screening process itself.
4. Missing complete search strategy — You must report the full search string for at least one database. "We searched PubMed using relevant keywords" is not acceptable.
5. No PRISMA checklist submitted — Many journals require the completed 27-item checklist as a supplementary file at submission. Don't forget to fill and attach it.
6. No PROSPERO registration — While not strictly mandatory, an increasing number of journals treat pre-registration as a submission requirement. Register at PROSPERO before starting your review.

Expert Tips for a Publication-Ready PRISMA Diagram

Tip 1: Run the Numbers Check Before Submission

Create a simple spreadsheet that tracks your flow: Total → Deduplicated → Screened → Full-text → Included. At every stage, "kept + excluded = previous stage total." If this doesn't hold, find and fix the discrepancy before submitting.

Tip 2: Be Specific About Exclusion Reasons

Don't use vague categories like "not relevant" or "doesn't meet criteria." Map your exclusion reasons to PICO components: wrong Population, wrong Intervention, wrong Comparator, wrong Outcome, or wrong study design. This makes your diagram both informative and PRISMA 2020-compliant.

Tip 3: Document Each Database Separately

PRISMA 2020 requires individual database counts. Keep a log during your search: "PubMed: 234, Embase: 189, Cochrane: 56, Web of Science: 312." This avoids the retroactive guessing that leads to errors.

Tip 4: Include the "Previous Studies" Source

PRISMA 2020 adds a right-side pathway for studies found through citation searching, hand searching reference lists, or expert recommendations. Even if this number is zero, include it to show you considered these sources.

Tip 5: Export as SVG for Best Quality

SVG (Scalable Vector Graphics) produces crisp, infinitely scalable diagrams perfect for journal production. If your journal requires raster images, export as PNG at 2x resolution (MetaReview does this automatically). Avoid screenshot-based submissions.

PRISMA Extensions You Should Know

Beyond the standard PRISMA 2020 statement, several extensions exist for specific review types: