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Systematic Review | Definition, Example, & Guide

Systematic Review | Definition, Example & Guide

Published on June 15, 2022 by Shaun Turney . Revised on November 20, 2023.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question “What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?”

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

What is a systematic review, systematic review vs. meta-analysis, systematic review vs. literature review, systematic review vs. scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, other interesting articles, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce bias . The methods are repeatable, and the approach is formal and systematic:

Formulate a research question
Develop a protocol
Search for all relevant studies
Apply the selection criteria
Extract the data
Synthesize the data
Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesizing all available evidence and evaluating the quality of the evidence. Synthesizing means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

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Systematic reviews often quantitatively synthesize the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesize results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimize bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

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A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
If you’re doing a systematic review on your own (e.g., for a research paper or thesis ), you should take appropriate measures to ensure the validity and reliability of your research.
Access to databases and journal archives. Often, your educational institution provides you with access.
Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

They minimize research bias by considering all available evidence and evaluating each study for bias.
Their methods are transparent , so they can be scrutinized by others.
They’re thorough : they summarize all available evidence.
They can be replicated and updated by others.

Systematic reviews also have a few cons .

They’re time-consuming .
They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

Allow you to more effectively communicate your research to other researchers and practitioners
Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

Population(s) or problem(s)
Intervention(s)
Comparison(s)

You can rearrange these four components to write your research question:

What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fifth component, the type of study design . In this case, the acronym is PICOT .

Type of study design(s)
The population of patients with eczema
The intervention of probiotics
In comparison to no treatment, placebo , or non-probiotic treatment
The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
Randomized control trials, a type of study design

Their research question was:

What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

Background information : Provide the context of the research question, including why it’s important.
Research objective (s) : Rephrase your research question as an objective.
Selection criteria: State how you’ll decide which studies to include or exclude from your review.
Search strategy: Discuss your plan for finding studies.
Analysis: Explain what information you’ll collect from the studies and how you’ll synthesize the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
Gray literature: Gray literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of gray literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of gray literature.
Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
Handsearch: Conference proceedings and reference lists of articles
Gray literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarize what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
Your judgment of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomized into the control and treatment groups.

Step 6: Synthesize the data

Synthesizing the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesizing the data:

Narrative ( qualitative ): Summarize the information in words. You’ll need to discuss the studies and assess their overall quality.
Quantitative : Use statistical methods to summarize and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analyzed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

Abstract : A summary of the review
Introduction : Including the rationale and objectives
Methods : Including the selection criteria, search method, data extraction method, and synthesis method
Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
Discussion : Including interpretation of the results and limitations of the review
Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

In their report, Boyle and colleagues concluded that probiotics cannot be recommended for reducing eczema symptoms or improving quality of life in patients with eczema. Note Generative AI tools like ChatGPT can be useful at various stages of the writing and research process and can help you to write your systematic review. However, we strongly advise against trying to pass AI-generated text off as your own work.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Student’s t -distribution
Normal distribution
Null and Alternative Hypotheses
Chi square tests
Confidence interval
Quartiles & Quantiles
Cluster sampling
Stratified sampling
Data cleansing
Reproducibility vs Replicability
Peer review
Prospective cohort study

Research bias

Implicit bias
Cognitive bias
Placebo effect
Hawthorne effect
Hindsight bias
Affect heuristic
Social desirability bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other academic texts , with an introduction , a main body, and a conclusion .

An annotated bibliography is a list of source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a paper .

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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1.2.2 What is a systematic review?

A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made (Antman 1992, Oxman 1993) . The key characteristics of a systematic review are:

a clearly stated set of objectives with pre-defined eligibility criteria for studies;

an explicit, reproducible methodology;

a systematic search that attempts to identify all studies that would meet the eligibility criteria;

an assessment of the validity of the findings of the included studies, for example through the assessment of risk of bias; and

a systematic presentation, and synthesis, of the characteristics and findings of the included studies.

Many systematic reviews contain meta-analyses. Meta-analysis is the use of statistical methods to summarize the results of independent studies (Glass 1976). By combining information from all relevant studies, meta-analyses can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review (see Chapter 9, Section 9.1.3 ). They also facilitate investigations of the consistency of evidence across studies, and the exploration of differences across studies.

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Knowledge Base
Methodology
Systematic Review | Definition, Examples & Guide

Systematic Review | Definition, Examples & Guide

Published on 15 June 2022 by Shaun Turney . Revised on 18 July 2024.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesise all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question ‘What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?’

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

What is a systematic review, systematic review vs meta-analysis, systematic review vs literature review, systematic review vs scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce research bias . The methods are repeatable , and the approach is formal and systematic:

Formulate a research question
Develop a protocol
Search for all relevant studies
Apply the selection criteria
Extract the data
Synthesise the data
Write and publish a report

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesising all available evidence and evaluating the quality of the evidence. Synthesising means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

Prevent plagiarism, run a free check.

Systematic reviews often quantitatively synthesise the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesise results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarise and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimise bias by using transparent and repeatable methods.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
If you’re doing a systematic review on your own (e.g., for a research paper or thesis), you should take appropriate measures to ensure the validity and reliability of your research.
Access to databases and journal archives. Often, your educational institution provides you with access.
Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

They minimise research b ias by considering all available evidence and evaluating each study for bias.
Their methods are transparent , so they can be scrutinised by others.
They’re thorough : they summarise all available evidence.
They can be replicated and updated by others.

Systematic reviews also have a few cons .

They’re time-consuming .
They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

Allow you to more effectively communicate your research to other researchers and practitioners
Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

Population(s) or problem(s)
Intervention(s)
Comparison(s)

You can rearrange these four components to write your research question:

What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fourth component, the type of study design . In this case, the acronym is PICOT .

Type of study design(s)
The population of patients with eczema
The intervention of probiotics
In comparison to no treatment, placebo , or non-probiotic treatment
The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
Randomised control trials, a type of study design

Their research question was:

What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

Background information : Provide the context of the research question, including why it’s important.
Research objective(s) : Rephrase your research question as an objective.
Selection criteria: State how you’ll decide which studies to include or exclude from your review.
Search strategy: Discuss your plan for finding studies.
Analysis: Explain what information you’ll collect from the studies and how you’ll synthesise the data.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
Grey literature: Grey literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of grey literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of grey literature.
Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
Handsearch: Conference proceedings and reference lists of articles
Grey literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

You should apply the selection criteria in two phases:

Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarise what you did using a PRISMA flow diagram .

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
Your judgement of the quality of the evidence, including risk of bias .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomised into the control and treatment groups.

Step 6: Synthesise the data

Synthesising the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesising the data:

Narrative ( qualitative ): Summarise the information in words. You’ll need to discuss the studies and assess their overall quality.
Quantitative : Use statistical methods to summarise and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analysed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

Abstract : A summary of the review
Introduction : Including the rationale and objectives
Methods : Including the selection criteria, search method, data extraction method, and synthesis method
Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
Discussion : Including interpretation of the results and limitations of the review
Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a dissertation , thesis, research paper , or proposal .

There are several reasons to conduct a literature review at the beginning of a research project:

To familiarise yourself with the current state of knowledge on your topic
To ensure that you’re not just repeating what others have already done
To identify gaps in knowledge and unresolved problems that your research can address
To develop your theoretical framework and methodology
To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

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Turney, S. (2024, July 17). Systematic Review | Definition, Examples & Guide. Scribbr. Retrieved 19 August 2024, from https://www.scribbr.co.uk/research-methods/systematic-reviews/

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Systematic Reviews

What is a Systematic Review?

A systematic review is an evidence synthesis that uses explicit, reproducible methods to perform a comprehensive literature search and critical appraisal of individual studies and that uses appropriate statistical techniques to combine these valid studies.

Key Characteristics of a Systematic Review:

Generally, systematic reviews must have:

a clearly stated set of objectives with pre-defined eligibility criteria for studies
an explicit, reproducible methodology
a systematic search that attempts to identify all studies that would meet the eligibility criteria
an assessment of the validity of the findings of the included studies, for example through the assessment of the risk of bias
a systematic presentation, and synthesis, of the characteristics and findings of the included studies.

A meta-analysis is a systematic review that uses quantitative methods to synthesize and summarize the pooled data from included studies.

Additional Information

How-to Books
Beyond Health Sciences

Cochrane Handbook For Systematic Reviews of Interventions Provides guidance to authors for the preparation of Cochrane Intervention reviews. Chapter 6 covers searching for reviews.
Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Health Care From The University of York Centre for Reviews and Dissemination: Provides practical guidance for undertaking evidence synthesis based on a thorough understanding of systematic review methodology. It presents the core principles of systematic reviewing, and in complementary chapters, highlights issues that are specific to reviews of clinical tests, public health interventions, adverse effects, and economic evaluations.
Cornell, Sytematic Reviews and Evidence Synthesis Beyond the Health Sciences Video series geared for librarians but very informative about searching outside medicine.
<< Previous: Getting Started
Next: Levels of Evidence >>
Getting Started
Levels of Evidence
Locating Systematic Reviews
Searching Systematically
Developing Answerable Questions
Identifying Synonyms & Related Terms
Using Truncation and Wildcards
Identifying Search Limits/Exclusion Criteria
Keyword vs. Subject Searching
Where to Search
Search Filters
Sensitivity vs. Precision
Core Databases
Other Databases
Clinical Trial Registries
Conference Presentations
Databases Indexing Grey Literature
Web Searching
Handsearching
Citation Indexes
Documenting the Search Process
Managing your Review

Research Support

Last Updated: Aug 14, 2024 11:07 AM
URL: https://guides.library.ucdavis.edu/systematic-reviews

Systematic Review

Library Help
What is a Systematic Review (SR)?
Steps of a Systematic Review
Framing a Research Question
Developing a Search Strategy
Searching the Literature
Managing the Process
Meta-analysis
Publishing your Systematic Review

Introduction to Systematic Review

Introduction
Types of literature reviews
Other Libguides
Systematic review as part of a dissertation
Tutorials & Guidelines & Examples from non-Medical Disciplines

A "high-level overview of primary research on a focused question" utilizing high-quality research evidence through:

Source: Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at:

Depending on your learning style, please explore the resources in various formats on the tabs above.

For additional tutorials, visit the SR Workshop Videos from UNC at Chapel Hill outlining each stage of the systematic review process.

Know the difference! Systematic review vs. literature review

It is common to confuse systematic and literature reviews as both are used to provide a summary of the existent literature or research on a specific topic. Even with this common ground, both types vary significantly. Please review the following chart (and its corresponding poster linked below) for a detailed explanation of each as well as the differences between each type of review.

Source: Kysh, L. (2013). What’s in a name? The difference between a systematic review and a literature review and why it matters. [Poster] Retrieved from .

Check the website from UNC at Chapel Hill,

Types of literature reviews along with associated methodologies

JBI Manual for Evidence Synthesis . Find definitions and methodological guidance.

- Systematic Reviews - Chapters 1-7

- Mixed Methods Systematic Reviews - Chapter 8

- Diagnostic Test Accuracy Systematic Reviews - Chapter 9

- Umbrella Reviews - Chapter 10

- Scoping Reviews - Chapter 11

- Systematic Reviews of Measurement Properties - Chapter 12

Systematic reviews vs scoping reviews -

Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal , 26 (2), 91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x

Gough, D., Thomas, J., & Oliver, S. (2012). Clarifying differences between review designs and methods. Systematic Reviews, 1 (28). htt p s://doi.org/ 10.1186/2046-4053-1-28

Munn, Z., Peters, M., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review ? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18 (1), 143. https://doi.org/10.1186/s12874-018-0611-x. Also, check out the Libguide from Weill Cornell Medicine for the differences between a systematic review and a scoping review and when to embark on either one of them.

Sutton, A., Clowes, M., Preston, L., & Booth, A. (2019). Meeting the review family: Exploring review types and associated information retrieval requirements . Health Information & Libraries Journal , 36 (3), 202–222. https://doi.org/10.1111/hir.12276

Temple University. Review Types . - This guide provides useful descriptions of some of the types of reviews listed in the above article.

UMD Health Sciences and Human Services Library. Review Types . - Guide describing Literature Reviews, Scoping Reviews, and Rapid Reviews.

Whittemore, R., Chao, A., Jang, M., Minges, K. E., & Park, C. (2014). Methods for knowledge synthesis: An overview. Heart & Lung: The Journal of Acute and Critical Care, 43 (5), 453–461. https://doi.org/10.1016/j.hrtlng.2014.05.014

Differences between a systematic review and other types of reviews

Armstrong, R., Hall, B. J., Doyle, J., & Waters, E. (2011). ‘ Scoping the scope ’ of a cochrane review. Journal of Public Health , 33 (1), 147–150. https://doi.org/10.1093/pubmed/fdr015

Kowalczyk, N., & Truluck, C. (2013). Literature reviews and systematic reviews: What is the difference? Radiologic Technology , 85 (2), 219–222.

White, H., Albers, B., Gaarder, M., Kornør, H., Littell, J., Marshall, Z., Matthew, C., Pigott, T., Snilstveit, B., Waddington, H., & Welch, V. (2020). Guidance for producing a Campbell evidence and gap map . Campbell Systematic Reviews, 16 (4), e1125. https://doi.org/10.1002/cl2.1125. Check also this comparison between evidence and gaps maps and systematic reviews.

Rapid Reviews Tutorials

Rapid Review Guidebook by the National Collaborating Centre of Methods and Tools (NCCMT)

Hamel, C., Michaud, A., Thuku, M., Skidmore, B., Stevens, A., Nussbaumer-Streit, B., & Garritty, C. (2021). Defining Rapid Reviews: a systematic scoping review and thematic analysis of definitions and defining characteristics of rapid reviews. Journal of clinical epidemiology , 129 , 74–85. https://doi.org/10.1016/j.jclinepi.2020.09.041

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Müller, C., Lautenschläger, S., Meyer, G., & Stephan, A. (2017). Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review . International Journal of Nursing Studies, 71 , 139–152. https://doi.org/10.1016/j.ijnurstu.2017.03.013
Bhui, K. S., Aslam, R. W., Palinski, A., McCabe, R., Johnson, M. R. D., Weich, S., … Szczepura, A. (2015). Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: Systematic review . The British Journal of Psychiatry, 207 (2), 95–103. https://doi.org/10.1192/bjp.bp.114.158899
Rosen, L. J., Noach, M. B., Winickoff, J. P., & Hovell, M. F. (2012). Parental smoking cessation to protect young children: A systematic review and meta-analysis . Pediatrics, 129 (1), 141–152. https://doi.org/10.1542/peds.2010-3209

Scoping Review

Hyshka, E., Karekezi, K., Tan, B., Slater, L. G., Jahrig, J., & Wild, T. C. (2017). The role of consumer perspectives in estimating population need for substance use services: A scoping review . BMC Health Services Research, 171-14. https://doi.org/10.1186/s12913-017-2153-z
Olson, K., Hewit, J., Slater, L.G., Chambers, T., Hicks, D., Farmer, A., & ... Kolb, B. (2016). Assessing cognitive function in adults during or following chemotherapy: A scoping review . Supportive Care In Cancer, 24 (7), 3223-3234. https://doi.org/10.1007/s00520-016-3215-1
Pham, M. T., Rajić, A., Greig, J. D., Sargeant, J. M., Papadopoulos, A., & McEwen, S. A. (2014). A scoping review of scoping reviews: Advancing the approach and enhancing the consistency . Research Synthesis Methods, 5 (4), 371–385. https://doi.org/10.1002/jrsm.1123
Scoping Review Tutorial from UNC at Chapel Hill

Qualitative Systematic Review/Meta-Synthesis

Lee, H., Tamminen, K. A., Clark, A. M., Slater, L., Spence, J. C., & Holt, N. L. (2015). A meta-study of qualitative research examining determinants of children's independent active free play . International Journal Of Behavioral Nutrition & Physical Activity, 12 (5), 121-12. https://doi.org/10.1186/s12966-015-0165-9

Videos on systematic reviews


This video lecture explains in detail the steps necessary to conduct a systematic review (44 min.)	Here's a brief introduction to how to evaluate systematic reviews (16 min.)

Systematic Reviews: What are they? Are they right for my research? - 47 min. video recording with a closed caption option.

More training videos on systematic reviews:

from Yale University

(approximately 5-10 minutes each)

with Margaret Foster

(approximately 55 min each)

Books on Systematic Reviews

Books on Meta-analysis

University of Toronto Libraries - very detailed with good tips on the sensitivity and specificity of searches.
Monash University - includes an interactive case study tutorial.
Dalhousie University Libraries - a comprehensive How-To Guide on conducting a systematic review.

Guidelines for a systematic review as part of the dissertation

Guidelines for Systematic Reviews in the Context of Doctoral Education Background by University of Victoria (PDF)
Can I conduct a Systematic Review as my Master’s dissertation or PhD thesis? Yes, It Depends! by Farhad (blog)
What is a Systematic Review Dissertation Like? by the University of Edinburgh (50 min video)

Further readings on experiences of PhD students and doctoral programs with systematic reviews

Puljak, L., & Sapunar, D. (2017). Acceptance of a systematic review as a thesis: Survey of biomedical doctoral programs in Europe . Systematic Reviews , 6 (1), 253. https://doi.org/10.1186/s13643-017-0653-x

Perry, A., & Hammond, N. (2002). Systematic reviews: The experiences of a PhD Student . Psychology Learning & Teaching , 2 (1), 32–35. https://doi.org/10.2304/plat.2002.2.1.32

Daigneault, P.-M., Jacob, S., & Ouimet, M. (2014). Using systematic review methods within a Ph.D. dissertation in political science: Challenges and lessons learned from practice . International Journal of Social Research Methodology , 17 (3), 267–283. https://doi.org/10.1080/13645579.2012.730704

UMD Doctor of Philosophy Degree Policies

Before you embark on a systematic review research project, check the UMD PhD Policies to make sure you are on the right path. Systematic reviews require a team of at least two reviewers and an information specialist or a librarian. Discuss with your advisor the authorship roles of the involved team members. Keep in mind that the UMD Doctor of Philosophy Degree Policies (scroll down to the section, Inclusion of one's own previously published materials in a dissertation ) outline such cases, specifically the following:

" It is recognized that a graduate student may co-author work with faculty members and colleagues that should be included in a dissertation . In such an event, a letter should be sent to the Dean of the Graduate School certifying that the student's examining committee has determined that the student made a substantial contribution to that work. This letter should also note that the inclusion of the work has the approval of the dissertation advisor and the program chair or Graduate Director. The letter should be included with the dissertation at the time of submission. The format of such inclusions must conform to the standard dissertation format. A foreword to the dissertation, as approved by the Dissertation Committee, must state that the student made substantial contributions to the relevant aspects of the jointly authored work included in the dissertation."

by CommLab India

Cochrane Handbook for Systematic Reviews of Interventions - See Part 2: General methods for Cochrane reviews
Systematic Searches - Yale library video tutorial series
Using PubMed's Clinical Queries to Find Systematic Reviews - From the U.S. National Library of Medicine
Systematic reviews and meta-analyses: A step-by-step guide - From the University of Edinsburgh, Centre for Cognitive Ageing and Cognitive Epidemiology

by Vinova

Bioinformatics

Mariano, D. C., Leite, C., Santos, L. H., Rocha, R. E., & de Melo-Minardi, R. C. (2017). A guide to performing systematic literature reviews in bioinformatics . arXiv preprint arXiv:1707.05813.

Environmental Sciences

Collaboration for Environmental Evidence. 2018. Guidelines and Standards for Evidence synthesis in Environmental Management. Version 5.0 (AS Pullin, GK Frampton, B Livoreil & G Petrokofsky, Eds) www.environmentalevidence.org/information-for-authors .

Pullin, A. S., & Stewart, G. B. (2006). Guidelines for systematic review in conservation and environmental management. Conservation Biology, 20 (6), 1647–1656. https://doi.org/10.1111/j.1523-1739.2006.00485.x

Engineering Education

Borrego, M., Foster, M. J., & Froyd, J. E. (2014). Systematic literature reviews in engineering education and other developing interdisciplinary fields. Journal of Engineering Education, 103 (1), 45–76. https://doi.org/10.1002/jee.20038

Public Health

Hannes, K., & Claes, L. (2007). Learn to read and write systematic reviews: The Belgian Campbell Group . Research on Social Work Practice, 17 (6), 748–753. https://doi.org/10.1177/1049731507303106
McLeroy, K. R., Northridge, M. E., Balcazar, H., Greenberg, M. R., & Landers, S. J. (2012). Reporting guidelines and the American Journal of Public Health’s adoption of preferred reporting items for systematic reviews and meta-analyses . American Journal of Public Health, 102 (5), 780–784. https://doi.org/10.2105/AJPH.2011.300630
Pollock, A., & Berge, E. (2018). How to do a systematic review. International Journal of Stroke, 13 (2), 138–156. https://doi.org/10.1177/1747493017743796
Institute of Medicine. (2011). Finding what works in health care: Standards for systematic reviews . https://doi.org/10.17226/13059
Wanden-Berghe, C., & Sanz-Valero, J. (2012). Systematic reviews in nutrition: Standardized methodology . The British Journal of Nutrition, 107 Suppl 2, S3-7. https://doi.org/10.1017/S0007114512001432

Social Sciences

Bronson, D., & Davis, T. (2012). Finding and evaluating evidence: Systematic reviews and evidence-based practice (Pocket guides to social work research methods). Oxford: Oxford University Press.
Petticrew, M., & Roberts, H. (2006). Systematic reviews in the social sciences: A practical guide . Malden, MA: Blackwell Pub.
Cornell University Library Guide - Systematic literature reviews in engineering: Example: Software Engineering
Biolchini, J., Mian, P. G., Natali, A. C. C., & Travassos, G. H. (2005). Systematic review in software engineering . System Engineering and Computer Science Department COPPE/UFRJ, Technical Report ES, 679 (05), 45.
Biolchini, J. C., Mian, P. G., Natali, A. C. C., Conte, T. U., & Travassos, G. H. (2007). Scientific research ontology to support systematic review in software engineering . Advanced Engineering Informatics, 21 (2), 133–151.
Kitchenham, B. (2007). Guidelines for performing systematic literature reviews in software engineering . [Technical Report]. Keele, UK, Keele University, 33(2004), 1-26.
Weidt, F., & Silva, R. (2016). Systematic literature review in computer science: A practical guide . Relatórios Técnicos do DCC/UFJF , 1 .

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What are systematic reviews?

Watch this video from Cochrane Consumers and Communication to learn what systematic reviews are, how researchers prepare them, and why they’re an important part of making informed decisions about health - for everyone.

Cochrane evidence, including our systematic reviews, provides a powerful tool to enhance your healthcare knowledge and decision making. This video from Cochrane Sweden explains a bit about how we create health evidence and what Cochrane does.

Search our Plain Language Summaries of health evidence
Learn more about Cochrane and our work

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What are systematic reviews?

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Systematic reviews are a type of literature review of research that require equivalent standards of rigour to primary research. They have a clear, logical rationale that is reported to the reader of the review. They are used in research and policymaking to inform evidence-based decisions and practice. They differ from traditional literature reviews in the following elements of conduct and reporting.

Systematic reviews:

use explicit and transparent methods
are a piece of research following a standard set of stages
are accountable, replicable and updateable
involve users to ensure a review is relevant and useful.

For example, systematic reviews (like all research) should have a clear research question, and the perspective of the authors in their approach to addressing the question is described. There are clearly described methods on how each study in a review was identified, how that study was appraised for quality and relevance and how it is combined with other studies in order to address the review question. A systematic review usually involves more than one person in order to increase the objectivity and trustworthiness of the reviews methods and findings.

Research protocols for systematic reviews may be peer-reviewed and published or registered in a suitable repository to help avoid duplication of reviews and for comparisons to be made with the final review and the planned review.

History of systematic reviews to inform policy (EPPI-Centre)
Six reasons why it is important to be systematic (EPPI-Centre)
Evidence Synthesis International (ESI): Position Statement Describes the issues, principles and goals in synthesising research evidence to inform policy, practice and decisions

A 'non-systematic review' might use some of the same methods as systematic reviews, such as systematic approaches to identify studies or quality appraise the literature. There may be times when this approach can be useful. In a student dissertation, for example, there may not be the time to be fully systematic in a review of the literature if this is only one small part of the thesis. In other types of research, there may also be a need to obtain a quick and not necessarily thorough overview of a literature to inform some other work (including a systematic review). Another example, is where policymakers, or other people using research findings, want to make quick decisions and there is no systematic review available to help them. They have a choice of gaining a rapid overview of the research literature or not having any research evidence to help their decision-making.

Just like any other piece of research, the methods used to undertake any literature review should be carefully planned to justify the conclusions made.

Finding out about different types of systematic reviews and the methods used for systematic reviews, and reading both systematic and other types of review will help to understand some of the differences.

Typically, a systematic review addresses a focussed, structured research question in order to inform understanding and decisions on an area. (see the Formulating a research question section for examples).

Sometimes systematic reviews ask a broad research question, and one strategy to achieve this is the use of several focussed sub-questions each addressed by sub-components of the review.

Another strategy is to develop a map to describe the type of research that has been undertaken in relation to a research question. Some maps even describe over 2,000 papers, while others are much smaller. One purpose of a map is to help choose a sub-set of studies to explore more fully in a synthesis. There are also other purposes of maps: see the box on systematic evidence maps for further information.

Reporting standards specify minimum elements that need to go into the reporting of a review. The reporting standards refer mainly to methodological issues but they are not as detailed or specific as critical appraisal for the methodological standards of conduct of a review.

A number of organisations have developed specific guidelines and standards for both the conducting and reporting on systematic reviews in different topic areas.

PRISMA PRISMA is a reporting standard and is an acronym for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Key Documents section of the PRISMA website links to a checklist, flow diagram and explanatory notes. PRISMA is less useful for certain types of reviews, including those that are iterative.
eMERGe eMERGe is a reporting standard that has been developed for meta-ethnographies, a qualitative synthesis method.
ROSES: RepOrting standards for Systematic Evidence Syntheses Reporting standards, including forms and flow diagram, designed specifically for systematic reviews and maps in the field of conservation and environmental management.

Useful books about systematic reviews

Systematic approaches to a successful literature review

An introduction to systematic reviews

Cochrane handbook for systematic reviews of interventions

Systematic reviews: crd's guidance for undertaking reviews in health care.

Finding what works in health care: Standards for systematic reviews

Systematic Reviews in the Social Sciences

Meta-analysis and research synthesis.

Research Synthesis and Meta-Analysis

Doing a Systematic Review

Literature reviews.

What is a literature review?
Why are literature reviews important?
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A systematic review is an authoritative account of existing evidence using reliable, objective, thorough and reproducible research practices.

It is a method of making sense of large bodies of information and contributes to the answers to questions about what works and what doesn't.

Systematic reviews map areas of uncertainty and identify where little or no relevant research has been done, but where new studies are needed.

It is a good idea to familiarise yourself with the systematic review process before beginning your review. You can do this by searching for other systematic reviews to look at as examples, by reading a glossary of commonly used terms , and by learning how to distinguish between types of systematic review.

Characteristics of a systematic review

Some characteristics, or features, of systematic reviews are:

Clearly stated set of objectives with pre-defined eligibility criteria
Explicit, reproducible methodology
A systematic search that attempts to identify all studies that would meet the eligibility criteria
Assesses the validity of the findings, for example assessing the risk of bias
Systematic presentation and synthesis of the findings of the included studies. (Cochrane Handbook for Systematic Reviews of Interventions, 2008, p. 6).

Watch this video from the Cochrane Library for more information about systematic reviews.

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Systematic Reviews: What is a Systematic Review?

What is a Systematic Review?
Best Practices and Standards
Librarian Collaboration
The Research Question
Register Your Protocol
Inclusion/Exclusion Criteria
Search Strategies
Study Selection and Screening Management
Quality Assessment
Reference Management

systematic review graphic with cog wheels and light bulb

Definition and Elements

A systematic review is a comprehensive literature search that tries to answer a focused research question using existing research as evidence.

Elements of a Systemic Review:

Research team : including two independent screeners, a tie-breaker, librarian, and statistician
Focused research question , including a measurable outcome
Written and registered protocol : PROSPERO
Inclusion/exclusion criteria
Comprehensive literature searches of multiple databases: often performed by a librarian
Screening and study selection : two independent screeners, conflicts resolved by third reviewer
Quality assessment : transparent assessment using validated tools
Reporting guidelines : following PRISMA checklist
Time : systematic reviews can take at least 12 months to complete

Types of Reviews

Although systematic reviews may be the best known review type, there are a variety of different types of literature reviews that vary in terms of scope, comprehensiveness, time constraints, and types of studies included.

Grant, M.J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26, 91–108. Higgins JPT, Green S (editors).Box 2.3.b: Timeline for a Cochrane review. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. Available from http://handbook-5-1.cochrane.org. Accessed February 16, 2018.

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Some content in this guide has been copied, with permission, from : What is a Systematic Review? - Systematic Reviews - Guides at Medical University of South Carolina (libguides.com)

Many thanks to the staff at MUSC Libraries for their generosity in sharing this content.

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A high-quality systematic review is described as the most reliable source of evidence to guide clinical practice. The purpose of a systematic review is to deliver a meticulous summary of all the available primary research in response to a research question. A systematic review uses all the existing research and is sometime called ‘secondary research’ (research on research). They are often required by research funders to establish the state of existing knowledge and are frequently used in guideline development. Systematic review findings are often used within the …

Competing interests None.

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Systematic Reviews

Describes what is involved with conducting a systematic review of the literature for evidence-based public health and how the librarian is a partner in the process.

Several CDC librarians have special training in conducting literature searches for systematic reviews. Literature searches for systematic reviews can take a few weeks to several months from planning to delivery.

Fill out a search request form here or contact the Stephen B. Thacker CDC Library by email [email protected] or telephone 404-639-1717.

Campbell Collaboration

Cochrane Collaboration

Eppi Centre

Joanna Briggs Institute

McMaster University

PRISMA Statement

Systematic Reviews – CRD’s Guide

Systematic Reviews of Health Promotion and Public Health Interventions

The Guide to Community Preventive Services

Look for systematic reviews that have already been published.

To ensure that the work has not already been done.
To provides examples of search strategies for your topic

Look in PROSPERO for registered systematic reviews.

Search Cochrane and CRD-York for systematic reviews.

Search filter for finding systematic reviews in PubMed

Other search filters to locate systematic reviews

A systematic review attempts to collect and analyze all evidence that answers a specific question. The question must be clearly defined and have inclusion and exclusion criteria. A broad and thorough search of the literature is performed and a critical analysis of the search results is reported and ultimately provides a current evidence-based answer to the specific question.

Time: According to Cochrane , it takes 18 months on average to complete a Systematic Review.

The average systematic review from beginning to end requires 18 months of work. “…to find out about a healthcare intervention it is worth searching research literature thoroughly to see if the answer is already known. This may require considerable work over many months…” ( Cochrane Collaboration )

Review Team: Team Members at minimum…

Content expert
2 reviewers
1 tie breaker
1 statistician (meta-analysis)
1 economist if conducting an economic analysis
*1 librarian (expert searcher) trained in systematic reviews

“Expert searchers are an important part of the systematic review team, crucial throughout the review process-from the development of the proposal and research question to publication.” ( McGowan & Sampson, 2005 )

*Ask your librarian to write a methods section regarding the search methods and to give them co-authorship. You may also want to consider providing a copy of one or all of the search strategies used in an appendix.

The Question to Be Answered: A clearly defined and specific question or questions with inclusion and exclusion criteria.

Written Protocol: Outline the study method, rationale, key questions, inclusion and exclusion criteria, literature searches, data abstraction and data management, analysis of quality of the individual studies, synthesis of data, and grading of the evidience for each key question.

Literature Searches: Search for any systematic reviews that may already answer the key question(s). Next, choose appropriate databases and conduct very broad, comprehensive searches. Search strategies must be documented so that they can be duplicated. The librarian is integral to this step of the process. Before your librarian creates a search strategy and starts searching in earnest you should write a detailed PICO question , determine the inclusion and exclusion criteria for your study, run a preliminary search, and have 2-4 articles that already fit the criteria for your review.

What is searched depends on the topic of the review but should include…

At least 3 standard medical databases like PubMed/Medline, CINAHL, Embase, etc..
At least 2 grey literature resources like Clinicaltrials.gov, COS Conference Papers Index, Grey Literature Report, etc…

Citation Management: EndNote is a bibliographic management tools that assist researchers in managing citations. The Stephen B. Thacker CDC Library oversees the site license for EndNote.

To request installation: The library provides EndNote to CDC staff under a site-wide license. Please use the ITSO Software Request Tool (SRT) and submit a request for the latest version (or upgraded version) of EndNote. Please be sure to include the computer name for the workstation where you would like to have the software installed.

EndNote Training: CDC Library offers training on EndNote on a regular basis – both a basic and advanced course. To view the course descriptions and upcoming training dates, please visit the CDC Library training page .

For assistance with EndNote software, please contact [email protected]

Vendor Support and Services: EndNote – Support and Services (Thomson Reuters) EndNote – Tutorials and Live Online Classes (Thomson Reuters)

Getting Articles:

Articles can be obtained using DocExpress or by searching the electronic journals at the Stephen B. Thacker CDC Library.

IOM Standards for Systematic Reviews: Standard 3.1: Conduct a comprehensive systematic search for evidence

The goal of a systematic review search is to maximize recall and precision while keeping results manageable. Recall (sensitivity) is defined as the number of relevant reports identified divided by the total number of relevant reports in existence. Precision (specificity) is defined as the number of relevant reports identified divided by the total number of reports identified.

Issues to consider when creating a systematic review search:

All concepts are included in the strategy
All appropriate subject headings are used
Appropriate use of explosion
Appropriate use of subheadings and floating subheadings
Use of natural language (text words) in addition to controlled vocabulary terms
Use of appropriate synonyms, acronyms, etc.
Truncation and spelling variation as appropriate
Appropriate use of limits such as language, years, etc.
Field searching, publication type, author, etc.
Boolean operators used appropriately
Line errors: when searches are combined using line numbers, be sure the numbers refer to the searches intended
Check indexing of relevant articles
Search strategy adapted as needed for multiple databases
Cochrane Handbook: Searching for Studies See Part 2, Chapter 6

A step-by-step guide to systematically identify all relevant animal studies

Materials listed in these guides are selected to provide awareness of quality public health literature and resources. A material’s inclusion does not necessarily represent the views of the U.S. Department of Health and Human Services (HHS), the Public Health Service (PHS), or the Centers for Disease Control and Prevention (CDC), nor does it imply endorsement of the material’s methods or findings. HHS, PHS, and CDC assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by HHS, PHS, and CDC. Opinion, findings, and conclusions expressed by the original authors of items included in these materials, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of HHS, PHS, or CDC. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by HHS, PHS, or CDC.

Systematic Reviews

What is a Systematic Review?
Request Form
Getting Started
Systematic Review Process
Question Frameworks
Key Resources

Definition of Systematic Review

"A systematic review attempts to identify, appraise, and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias, in order to produce more reliable findings that can be used to inform decision making."

- About Cochrane Reviews, Cochrane Library

Systematic reviews are part of a larger category of research methodologies known as evidence syntheses or knowledge syntheses. While many types of evidence syntheses exist, these are the methodologies that the Dana Health Sciences Library is prepared to support and collaborate on.

Review Methods

There are many types of reviews, and choosing the right one can be challenging. The list below provides a general overview of six popular review types. If you are still unsure of which one to choose, please try the Right Review tool, which asks you a series of questions to help you determine which review methodology might be suitable for your project. When you are finished, please feel free to discuss the results with your librarian .

Chart adapted from: Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies . Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x.

Standards & Guidance References

Here are some standards and additional research synthesis methods papers to get you started:

Chandler, J., Churchill, R., Higgins, J., Lasserson, T., & Tovey, D. (2013). Methodological standards for the conduct of new Cochrane Intervention Reviews, Version 2.3. Available from http://www.editorial-unit.cochrane.org/mecir .

European Network for Health Technology Assessment. (2019) Guideline: Process of information retrieval for systematic reviews and health technology assessments on clinical effectiveness Version 2.0. DEC 2019. Available from: https://www.eunethta.eu/wp-content/uploads/2020/01/EUnetHTA_Guideline_Information_Retrieval_v2-0.pdf .

Higgins, J., Green, S., & (editors). (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. J. Higgins & S. Green (Eds.), Available from: http://handbook.cochrane.org/ .

IOM (Institute of Medicine). (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Available from: https://www.nap.edu/catalog/13059/finding-what-works-in-health-care-standards-for-systematic-reviews .

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P., . . . Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine, 6(7), e1000100. doi: 10.1371/journal.pmed.1000100. Available from: https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000100&type=printable .

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), e1000097. doi: 10.1371/journal.pmed.1000097. Available from: https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000097&type=printable .

Moher D., Shamseer L., Clarke M., Ghersi D., Liberati A., Petticrew M., . . . PRISMA-P Group (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), doi:10.1186/2046-4053-4-1. Availalble from: https://www.bmj.com/content/bmj/349/bmj.g7647.full.pdf .

Rader, T., Mann, M., Stansfield, C., Cooper, C., & Sampson, M. (2013). Methods for documenting systematic review searches: a discussion of common issues. Research Synthesis Methods, Article first published online: 8 OCT 2013. doi: 10.1002/jrsm.1097. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/jrsm.1097 .

Rethlefsen, M. L., Murad, M., & Livingston, E. H. (2014). Engaging medical librarians to improve the quality of review articles. JAMA, 312(10), 999-1000. doi: 10.1001/jama.2014.9263. Availalble from: https://jamanetwork.com/journals/jama/fullarticle/1902238 .

Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A. D., Petticrew, M., . . . PRISMA-P Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ, 349, g7647. doi: 10.1136/bmj.g7647. Available from: https://www.bmj.com/content/bmj/349/bmj.g7647.full.pdf .

Umscheid, C. A. (2013). A Primer on Performing Systematic Reviews and Meta-analyses. Clinical Infectious Diseases, 57(5), 725-734. doi: 10.1093/cid/cit333. Available from: https://academic.oup.com/cid/article/57/5/725/311245 .

This website has been adapted from the Northwestern University Galter Health Sciences Library's Systematic Reviews guide.

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Easy guide to conducting a systematic review

Affiliations.

1 Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
2 Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
3 Education Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
PMID: 32364273
DOI: 10.1111/jpc.14853

A systematic review is a type of study that synthesises research that has been conducted on a particular topic. Systematic reviews are considered to provide the highest level of evidence on the hierarchy of evidence pyramid. Systematic reviews are conducted following rigorous research methodology. To minimise bias, systematic reviews utilise a predefined search strategy to identify and appraise all available published literature on a specific topic. The meticulous nature of the systematic review research methodology differentiates a systematic review from a narrative review (literature review or authoritative review). This paper provides a brief step by step summary of how to conduct a systematic review, which may be of interest for clinicians and researchers.

Keywords: research; research design; systematic review.

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Evidence Synthesis and Systematic Reviews

Question Formulation

Systematic Reviews

Rapid reviews, scoping reviews.

Other Review Types
Resources for Reviews by Discipline and Type
Tools for Evidence Synthesis
Grey Literature

Definition : A systematic review is a summary of research results (evidence) that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and errors.

When to use : If you want to identify, appraise, and synthesize all available research that is relevant to a particular question with reproduceable search methods.

Limitations : It requires extensive time and a team

Resources :

Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare
The 8 stages of a systematic review
Determining the scope of the review and the questions it will address
Reporting the review

Definition : Rapid reviews are a form of evidence synthesis that may provide more timely information for decision making compared with standard systematic reviews

When to use : When you want to evaluate new or emerging research topics using some systematic review methods at a faster pace

Limitations : It is not as rigorous or as thorough as a systematic review and therefore may be more likely to be biased

Cochrane guidance for rapid reviews
Steps for conducting a rapid review
Expediting systematic reviews: methods and implications of rapid reviews

Definition : Scoping reviews are often used to categorize or group existing literature in a given field in terms of its nature, features, and volume.

When to use : Label body of literature with relevance to time, location (e.g. country or context), source (e.g. peer-reviewed or grey literature), and origin (e.g. healthcare discipline or academic field) It also is used to clarify working definitions and conceptual boundaries of a topic or field or to identify gaps in existing literature/research

Limitations : More citations to screen and takes as long or longer than a systematic review. Larger teams may be required because of the larger volumes of literature. Different screening criteria and process than a systematic review

PRISMA-ScR for scoping reviews
JBI Updated methodological guidance for the conduct of scoping reviews
JBI Manual: Scoping Reviews (2020)
Equator Network-Current Best Practices for the Conduct of Scoping Reviews
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J Family Med Prim Care
v.2(1); Jan-Mar 2013

Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare

S. gopalakrishnan.

Department of Community Medicine, SRM Medical College, Hospital and Research Centre, Kattankulathur, Tamil Nadu, India

P. Ganeshkumar

Healthcare decisions for individual patients and for public health policies should be informed by the best available research evidence. The practice of evidence-based medicine is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient's values and expectations. Primary care physicians need evidence for both clinical practice and for public health decision making. The evidence comes from good reviews which is a state-of-the-art synthesis of current evidence on a given research question. Given the explosion of medical literature, and the fact that time is always scarce, review articles play a vital role in decision making in evidence-based medical practice. Given that most clinicians and public health professionals do not have the time to track down all the original articles, critically read them, and obtain the evidence they need for their questions, systematic reviews and clinical practice guidelines may be their best source of evidence. Systematic reviews aim to identify, evaluate, and summarize the findings of all relevant individual studies over a health-related issue, thereby making the available evidence more accessible to decision makers. The objective of this article is to introduce the primary care physicians about the concept of systematic reviews and meta-analysis, outlining why they are important, describing their methods and terminologies used, and thereby helping them with the skills to recognize and understand a reliable review which will be helpful for their day-to-day clinical practice and research activities.

Introduction

Evidence-based healthcare is the integration of best research evidence with clinical expertise and patient values. Green denotes, “Using evidence from reliable research, to inform healthcare decisions, has the potential to ensure best practice and reduce variations in healthcare delivery.” However, incorporating research into practice is time consuming, and so we need methods of facilitating easy access to evidence for busy clinicians.[ 1 ] Ganeshkumar et al . mentioned that nearly half of the private practitioners in India were consulting more than 4 h per day in a locality,[ 2 ] which explains the difficulty of them in spending time in searching evidence during consultation. Ideally, clinical decision making ought to be based on the latest evidence available. However, to keep abreast with the continuously increasing number of publications in health research, a primary healthcare professional would need to read an insurmountable number of articles every day, covered in more than 13 million references and over 4800 biomedical and health journals in Medline alone. With the view to address this challenge, the systematic review method was developed. Systematic reviews aim to inform and facilitate this process through research synthesis of multiple studies, enabling increased and efficient access to evidence.[ 1 , 3 , 4 ]

Systematic reviews and meta-analyses have become increasingly important in healthcare settings. Clinicians read them to keep up-to-date with their field 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 and some healthcare journals are moving in this direction.[ 5 ]

This article is intended to provide an easy guide to understand the concept of systematic reviews and meta-analysis, which has been prepared with the aim of capacity building for general practitioners and other primary healthcare professionals in research methodology and day-to-day clinical practice.

The purpose of this article is to introduce readers to:

The two approaches of evaluating all the available evidence on an issue i.e., systematic reviews and meta-analysis,
Discuss the steps in doing a systematic review,
Introduce the terms used in systematic reviews and meta-analysis,
Interpret results of a meta-analysis, and
The advantages and disadvantages of systematic review and meta-analysis.

Application

What is the effect of antiviral treatment in dengue fever? Most often a primary care physician needs to know convincing answers to questions like this in a primary care setting.

To find out the solutions or answers to a clinical question like this, one has to refer textbooks, ask a colleague, or search electronic database for reports of clinical trials. Doctors need reliable information on such problems and on the effectiveness of large number of therapeutic interventions, but the information sources are too many, i.e., nearly 20,000 journals publishing 2 million articles per year with unclear or confusing results. Because no study, regardless of its type, should be interpreted in isolation, a systematic review is generally the best form of evidence.[ 6 ] So, the preferred method is a good summary of research reports, i.e., systematic reviews and meta-analysis, which will give evidence-based answers to clinical situations.

There are two fundamental categories of research: Primary research and secondary research. Primary research is collecting data directly from patients or population, while secondary research is the analysis of data already collected through primary research. A review is an article that summarizes a number of primary studies and may draw conclusions on the topic of interest which can be traditional (unsystematic) or systematic.

Terminologies

Systematic review.

A systematic review is a summary of the medical literature that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and random errors.[ 7 ] To this end, systematic reviews may or may not include a statistical synthesis called meta-analysis, depending on whether the studies are similar enough so that combining their results is meaningful.[ 8 ] Systematic reviews are often called overviews.

The evidence-based practitioner, David Sackett, defines the following terminologies.[ 3 ]

Review: The general term for all attempts to synthesize the results and conclusions of two or more publications on a given topic.
Overview: When a review strives to comprehensively identify and track down all the literature on a given topic (also called “systematic literature review”).
Meta-analysis: A specific statistical strategy for assembling the results of several studies into a single estimate.

Systematic reviews adhere to a strict scientific design based on explicit, pre-specified, and reproducible methods. Because of this, when carried out well, they provide reliable estimates about the effects of interventions so that conclusions are defensible. Systematic reviews can also demonstrate where knowledge is lacking. This can then be used to guide future research. Systematic reviews are usually carried out in the areas of clinical tests (diagnostic, screening, and prognostic), public health interventions, adverse (harm) effects, economic (cost) evaluations, and how and why interventions work.[ 9 ]

Cochrane reviews

Cochrane reviews are systematic reviews undertaken by members of the Cochrane Collaboration which is an international not-for-profit organization that aims to help people to make well-informed decisions about healthcare by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of healthcare interventions.

Cochrane Primary Health Care Field is a systematic review of primary healthcare research on prevention, treatment, rehabilitation, and diagnostic test accuracy. The overall aim and mission of the Primary Health Care Field is to promote the quality, quantity, dissemination, accessibility, applicability, and impact of Cochrane systematic reviews relevant to people who work in primary care and to ensure proper representation in the interests of primary care clinicians and consumers in Cochrane reviews and review groups, and in other entities. This field would serve to coordinate and promote the mission of the Cochrane Collaboration within the primary healthcare disciplines, as well as ensuring that primary care perspectives are adequately represented within the Collaboration.[ 10 ]

Meta-analysis

A meta-analysis is the combination of data from several independent primary studies that address the same question to produce a single estimate like the effect of treatment or risk factor. It is the statistical analysis of a large collection of analysis and results from individual studies for the purpose of integrating the findings.[ 11 ] The term meta-analysis has been used to denote the full range of quantitative methods for research reviews.[ 12 ] Meta-analyses are studies of studies.[ 13 ] Meta-analysis provides a logical framework to a research review where similar measures from comparable studies are listed systematically and the available effect measures are combined wherever possible.[ 14 ]

The fundamental rationale of meta-analysis is that it reduces the quantity of data by summarizing data from multiple resources and helps to plan research as well as to frame guidelines. It also helps to make efficient use of existing data, ensuring generalizability, helping to check consistency of relationships, explaining data inconsistency, and quantifies the data. It helps to improve the precision in estimating the risk by using explicit methods.

Therefore, “systematic review” will refer to the entire process of collecting, reviewing, and presenting all available evidence, while the term “meta-analysis” will refer to the statistical technique involved in extracting and combining data to produce a summary result.[ 15 ]

Steps in doing systematic reviews/meta-analysis

Following are the six fundamental essential steps while doing systematic review and meta-analysis.[ 16 ]

Define the question

This is the most important part of systematic reviews/meta-analysis. The research question for the systematic reviews may be related to a major public health problem or a controversial clinical situation which requires acceptable intervention as a possible solution to the present healthcare need of the community. This step is most important since the remaining steps will be based on this.

Reviewing the literature

This can be done by going through scientific resources such as electronic database, controlled clinical trials registers, other biomedical databases, non-English literatures, “gray literatures” (thesis, internal reports, non–peer-reviewed journals, pharmaceutical industry files), references listed in primary sources, raw data from published trials and other unpublished sources known to experts in the field. Among the available electronic scientific database, the popular ones are PUBMED, MEDLINE, and EMBASE.

Sift the studies to select relevant ones

To select the relevant studies from the searches, we need to sift through the studies thus identified. The first sift is pre-screening, i.e., to decide which studies to retrieve in full, and the second sift is selection which is to look again at these studies and decide which are to be included in the review. The next step is selecting the eligible studies based on similar study designs, year of publication, language, choice among multiple articles, sample size or follow-up issues, similarity of exposure, and or treatment and completeness of information.

It is necessary to ensure that the sifting includes all relevant studies like the unpublished studies (desk drawer problem), studies which came with negative conclusions or were published in non-English journals, and studies with small sample size.

Assess the quality of studies

The steps undertaken in evaluating the study quality are early definition of study quality and criteria, setting up a good scoring system, developing a standard form for assessment, calculating quality for each study, and finally using this for sensitivity analysis.

For example, the quality of a randomized controlled trial can be assessed by finding out the answers to the following questions:

Was the assignment to the treatment groups really random?
Was the treatment allocation concealed?
Were the groups similar at baseline in terms of prognostic factors?
Were the eligibility criteria specified?
Were the assessors, the care provider, and the patient blinded?
Were the point estimates and measure of variability presented for the primary outcome measure?
Did the analyses include intention-to-treat analysis?

Calculate the outcome measures of each study and combine them

We need a standard measure of outcome which can be applied to each study on the basis of its effect size. Based on their type of outcome, following are the measures of outcome: Studies with binary outcomes (cured/not cured) have odds ratio, risk ratio; studies with continuous outcomes (blood pressure) have means, difference in means, standardized difference in means (effect sizes); and survival or time-to-event data have hazard ratios.

Combining studies

Homogeneity of different studies can be estimated at a glance from a forest plot (explained below). For example, if the lower confidence interval of every trial is below the upper of all the others, i.e., the lines all overlap to some extent, then the trials are homogeneous. If some lines do not overlap at all, these trials may be said to be heterogeneous.

The definitive test for assessing the heterogeneity of studies is a variant of Chi-square test (Mantel–Haenszel test). The final step is calculating the common estimate and its confidence interval with the original data or with the summary statistics from all the studies. The best estimate of treatment effect can be derived from the weighted summary statistics of all studies which will be based on weighting to sample size, standard errors, and other summary statistics. Log scale is used to combine the data to estimate the weighting.

Interpret results: Graph

The results of a meta-analysis are usually presented as a graph called forest plot because the typical forest plots appear as forest of lines. It provides a simple visual presentation of individual studies that went into the meta-analysis at a glance. It shows the variation between the studies and an estimate of the overall result of all the studies together.

Forest plot

Meta-analysis graphs can principally be divided into six columns [ Figure 1 ]. Individual study results are displayed in rows. The first column (“study”) lists the individual study IDs included in the meta-analysis; usually the first author and year are displayed. The second column relates to the intervention groups and the third column to the control groups. The fourth column visually displays the study results. The line in the middle is called “the line of no effect.” The weight (in %) in the fifth column indicates the weighting or influence of the study on the overall results of the meta-analysis of all included studies. The higher the percentage weight, the bigger the box, the more influence the study has on the overall results. The sixth column gives the numerical results for each study (e.g., odds ratio or relative risk and 95% confidence interval), which are identical to the graphical display in the fourth column. The diamond in the last row of the graph illustrates the overall result of the meta-analysis.[ 4 ]

An external file that holds a picture, illustration, etc.
Object name is JFMPC-2-9-g001.jpg

Interpretation of meta-analysis[ 4 ]

Thus, the horizontal lines represent individual studies. Length of line is the confidence interval (usually 95%), squares on the line represent effect size (risk ratio) for the study, with area of the square being the study size (proportional to weight given) and position as point estimate (relative risk) of the study.[ 7 ]

For example, the forest plot of the effectiveness of dexamethasone compared with placebo in preventing the recurrence of acute severe migraine headache in adults is shown in Figure 2 .[ 17 ]

An external file that holds a picture, illustration, etc.
Object name is JFMPC-2-9-g002.jpg

Forest plot of the effectiveness of dexamethasone compared with placebo in preventing the recurrence of acute severe migraine headache in adults[ 17 ]

The overall effect is shown as diamond where the position toward the center represents pooled point estimate, the width represents estimated 95% confidence interval for all studies, and the black plain line vertically in the middle of plot is the “line of no effect” (e.g., relative risk = 1).

Therefore, when examining the results of a systematic reviews/meta-analysis, the following questions should be kept in mind:

Heterogeneity among studies may make any pooled estimate meaningless.
The quality of a meta-analysis cannot be any better than the quality of the studies it is summarizing.
An incomplete search of the literature can bias the findings of a meta-analysis.
Make sure that the meta-analysis quantifies the size of the effect in units that you can understand.

Subgroup analysis and sensitivity analysis

Subgroup analysis looks at the results of different subgroups of trials, e.g., by considering trials on adults and children separately. This should be planned at the protocol stage itself which is based on good scientific reasoning and is to be kept to a minimum.

Sensitivity analysis is used to determine how results of a systematic review/meta-analysis change by fiddling with data, for example, what is the implication if the exclusion criteria or excluded unpublished studies or weightings are assigned differently. Thus, after the analysis, if changing makes little or no difference to the overall results, the reviewer's conclusions are robust. If the key findings disappear, then the conclusions need to be expressed more cautiously.

Advantages of Systematic Reviews

Systematic reviews have specific advantages because of using explicit methods which limit bias, draw reliable and accurate conclusions, easily deliver required information to healthcare providers, researchers, and policymakers, help to reduce the time delay in the research discoveries to implementation, improve the generalizability and consistency of results, generation of new hypotheses about subgroups of the study population, and overall they increase precision of the results.[ 18 ]

Limitations in Systematic Reviews/Meta-analysis

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.[ 5 ]

Even though systematic review and meta-analysis are considered the best evidence for getting a definitive answer to a research question, there are certain inherent flaws associated with it, such as the location and selection of studies, heterogeneity, loss of information on important outcomes, inappropriate subgroup analyses, conflict with new experimental data, and duplication of publication.

Publication Bias

Publication bias results in it being easier to find studies with a “positive” result.[ 19 ] This occurs particularly due to inappropriate sifting of the studies where there is always a tendency towards the studies with positive (significant) outcomes. This effect occurs more commonly in systematic reviews/meta-analysis which need to be eliminated.

The quality of reporting of systematic reviews is still not optimal. In a recent review of 300 systematic reviews, few authors reported assessing possible publication bias even though there is overwhelming evidence both for its existence and its impact on the results of systematic reviews. Even when the possibility of publication bias is assessed, there is no guarantee that systematic reviewers have assessed or interpreted it appropriately.[ 20 ]

To overcome certain limitations mentioned above, the Cochrane reviews are currently reported in a format where at the end of every review, findings are summarized in the author's point of view and also give an overall picture of the outcome by means of plain language summary. This is found to be much helpful to understand the existing evidence about the topic more easily by the reader.

A systematic review is an overview of primary studies which contains an explicit statement of objectives, materials, and methods, and has been conducted according to explicit and reproducible methodology. A meta-analysis is a mathematical synthesis of the results of two or more primary studies that addressed the same hypothesis in the same way. Although meta-analysis can increase the precision of a result, it is important to ensure that the methods used for the reviews were valid and reliable.

High-quality systematic reviews and meta-analyses take great care to find all relevant studies, critically assess each study, synthesize the findings from individual studies in an unbiased manner, and present balanced important summary of findings with due consideration of any flaws in the evidence. Systematic review and meta-analysis is a way of summarizing research evidence, which is generally the best form of evidence, and hence positioned at the top of the hierarchy of evidence.

Systematic reviews can be very useful decision-making tools for primary care/family physicians. They objectively summarize large amounts of information, identifying gaps in medical research, and identifying beneficial or harmful interventions which will be useful for clinicians, researchers, and even for public and policymakers.

Source of Support: Nil

Conflict of Interest: None declared.

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What is a Systematic Review (SR)?

Evidence summaries come in many forms. One of the best-known types is the conventional literature review, which provides an overview of the relevant literature published on a topic. However, a conventional literature review’s trustworthiness is often low: clear criteria for inclusion are often lacking (including whether cited work is peer reviewed), studies are selected based on the researcher’s individual preferences, and the research methodology is generally not subjected to a critical appraisal . As a result, most conventional literature reviews are prone to severe bias and are therefore largely considered untrustworthy as an answer to questions relevant to practice.

For this reason, many evidence-based disciplines use so-called ‘systematic reviews’ instead. This type of review is a specific methodology that aims to comprehensively identify all relevant studies on a specific topic, and to select appropriate studies based on explicit criteria. In addition, the methodological quality of the studies included is assessed by on the basis of explicit criteria, such as the presence of a pre-test or a control group. In contrast to a conventional literature review, a systematic review (SR) is transparent, verifiable, and reproducible, and, as a result, the likelihood of bias is considerably smaller. Many SRs also include a meta-analysis, in which statistical analysis techniques are used to combine the results of individual studies to arrive at a more accurate estimate of effects .

In some cases, systematic reviews are not only used as a way to aggregate evidence relating to a specific topic, but also to make clear what is not known and, thereby, to direct new primary research into areas where there is a gap in the body of knowledge.

Although the SR methodology was originally developed in the field of medicine, its added value is evident in disciplines such as nursing, education, policing, criminology, public policy, and management. In disciplines in which evidence-based practice is well established, SRs are provided by global communities such as the Cochrane and Campbell collaborations. In management, however, the SR methodology is not yet widely adopted, and systematic reviews are consequently scarce.

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Analysing near-miss incidents in construction: a systematic literature review.

1. Introduction

Q 1 —Are near-miss events in construction industry the subject of scientific research?
Q 2 —What methods have been employed thus far to obtain information on near misses and systems for recording incidents in construction companies?
Q 3 —What methods have been used to analyse the information and figures obtained?
Q 4 —What are the key aspects of near misses in the construction industry that have been of interest to the researchers?

2. Definition of Near-Miss Events

3. research methodology, 4.1. a statistical analysis of publications, 4.2. methods used to obtain information about near misses, 4.2.1. traditional methods.

Traditional registration forms
Computerized systems for the recording of events
Surveys and interviews

4.2.2. Real-Time Monitoring Systems

Employee-tracking systems
Video surveillance systems
Wearable technology
Motion sensors

4.3. Methods Used to Analyse the Information and Figures That Have Been Obtained

4.3.1. quantitative and qualitative statistical methods, 4.3.2. analysis using artificial intelligence (ai), 4.3.3. building information modelling, 4.4. key aspects of near-miss investigations in the construction industry, 4.4.1. occupational risk assessment, 4.4.2. causes of hazards in construction, 4.4.3. time series of near misses, 4.4.4. material factors of construction processes, 4.5. a comprehensive overview of the research questions and references on near misses in the construction industry, 5. discussion, 5.1. interest of researchers in near misses in construction (question 1), 5.2. methods used to obtain near-miss information (question 2), 5.3. methods used to analyse the information and data sets (question 3), 5.4. key aspects of near-miss investigations in the construction industry (question 4), 6. conclusions.

A quantitative analysis of the Q 1 question has revealed a positive trend, namely that there is a growing interest among researchers in studying near misses in construction. The greatest interest in NM topics is observed in the United States of America, China, the United Kingdom, Australia, Hong Kong, and Germany. Additionally, there has been a recent emergence of interest in Poland. The majority of articles are mainly published in journals such as Safety Science (10), Journal of Construction Engineering and Management (8), and Automation in Construction (5);
The analysis of question Q 2 illustrates that traditional paper-based event registration systems are currently being superseded by advanced IT systems. However, both traditional and advanced systems are subject to the disadvantage of relying on employee-reported data, which introduces a significant degree of uncertainty regarding in the quality of the information provided. A substantial proportion of the data and findings presented in the studies was obtained through surveys and interviews. The implementation of real-time monitoring systems is becoming increasingly prevalent in construction sites. The objective of such systems is to provide immediate alerts in the event of potential hazards, thereby preventing a significant number of near misses. Real-time monitoring systems employ a range of technologies, including ultrasonic technology, radio frequency identification (RFID), inertial measurement units (IMUs), real-time location systems (RTLSs), industrial cameras, wearable technology, motion sensors, and advanced IT technologies, among others;
The analysis of acquired near-miss data is primarily conducted through the utilisation of quantitative and qualitative statistical methods, as evidenced by the examination of the Q 3 question. In recent years, research utilising artificial intelligence (AI) has made significant advances. The most commonly employed artificial intelligence techniques include text mining, machine learning, and artificial neural networks. The growing deployment of Building Information Modelling (BIM) technology has precipitated a profound transformation in the safety management of construction sites, with the advent of sophisticated tools for the identification and management of hazardous occurrences;
In response to question Q 4 , the study of near misses in the construction industry has identified several key aspects that have attracted the attention of researchers. These include the utilisation of both quantitative and qualitative methodologies for risk assessment, the analysis of the causes of hazards, the identification of accident precursors through the creation of time series, and the examination of material factors pertaining to construction processes. Researchers are focusing on the utilisation of both databases and advanced technologies, such as real-time location tracking, for the assessment and analysis of occupational risks. Techniques such as Analytic Hierarchy Process (AHP) and clustering facilitate a comprehensive assessment and categorisation of incidents, thereby enabling the identification of patterns and susceptibility to specific types of accidents. Moreover, the impact of a company’s safety climate and organisational culture on the frequency and characteristics of near misses represents a pivotal area of investigation. The findings of this research indicate that effective safety management requires a holistic approach that integrates technology, risk management and safety culture, with the objective of reducing accidents and enhancing overall working conditions on construction sites.

7. Gaps and Future Research Directions, Limitations

Given the diversity and variability of construction sites and the changing conditions and circumstances of work, it is essential to create homogeneous clusters of near misses and to analyse the phenomena within these clusters. The formation of such clusters may be contingent upon the direct causes of the events in question;
Given the inherently dynamic nature of construction, it is essential to analyse time series of events that indicate trends in development and safety levels. The numerical characteristics of these trends may be used to construct predictive models for future accidents and near misses;
The authors have identified potential avenues for future research, which could involve the development of mathematical models using techniques such as linear regression, artificial intelligence, and machine learning. The objective of these models is to predict the probable timing of occupational accidents within defined incident categories, utilising data from near misses. Moreover, efforts are being made to gain access to the hazardous incident recording systems of different construction companies, with a view to facilitating comparison of the resulting data;
One significant limitation of near-miss research is the lack of an integrated database that encompasses a diverse range of construction sites and construction work. A data resource of this nature would be of immense value for the purpose of conducting comprehensive analyses and formulating effective risk management strategies. This issue can be attributed to two factors: firstly, the reluctance of company managers to share their databases with researchers specialising in risk assessment, and secondly, the reluctance of employees to report near-miss incidents. Such actions may result in adverse consequences for employees, including disciplinary action or negative perceptions from managers. This consequently results in the recording of only a subset of incidents, thereby distorting the true picture of safety on the site.

Author Contributions

Institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Click here to enlarge figure

No.	Name of Institution/Organization	Definition
1	Occupational Safety and Health Administration (OSHA) [ ]	“A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred. Near misses also may be referred to as close calls, near accidents, or injury-free events.”
2	International Labour Organization (ILO) [ ]	“An event, not necessarily defined under national laws and regulations, that could have caused harm to persons at work or to the public, e.g., a brick that falls off scaffolding but does not hit anyone”
3	American National Safety Council (NSC) [ ]	“A Near Miss is an unplanned event that did not result in injury, illness, or damage—but had the potential to do so”
4	PN-ISO 45001:2018-06 [ ]	A near-miss incident is described as an event that does not result in injury or health issues.
5	PN-N-18001:2004 [ ]	A near-miss incident is an accident event without injury.
6	World Health Organization (WHO) [ ]	Near misses have been defined as a serious error that has the potential to cause harm but are not due to chance or interception.
7	International Atomic Energy Agency (IAEA) [ ]	Near misses have been defined as potentially significant events that could have consequences but did not due to the conditions at the time.

No.	Journal	Number of Publications
1	Safety Science	10
2	Journal of Construction Engineering and Management	8
3	Automation in Construction	5
4	Advanced Engineering Informatics	3
5	Construction Research Congress 2014 Construction in a Global Network Proceedings of the 2014 Construction Research Congress	3
6	International Journal of Construction Management	3
7	Accident Analysis and Prevention	2
8	Computing in Civil Engineering 2019 Data Sensing and Analytics Selected Papers From The ASCE International Conference	2
9	Engineering Construction and Architectural Management	2
10	Heliyon	2

Cluster Number	Colour	Basic Keywords
1	blue	construction, construction sites, decision making, machine learning, near misses, neural networks, project management, safety, workers
2	green	building industry, construction industry, construction projects, construction work, human, near miss, near misses, occupational accident, occupational safety, safety, management, safety performance
3	red	accident prevention, construction equipment, construction, safety, construction workers, hazards, human resource management, leading indicators, machinery, occupational risks, risk management, safety engineering
4	yellow	accidents, risk assessment, civil engineering, near miss, surveys

Number of Question	Question	References
Q	Are near misses in the construction industry studied scientifically?	[ , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ]
Q	What methods have been used to obtain information on near misses and systems for recording incidents in construction companies?	[ , , , , , , , , , , , , , , , , , , , , ]
Q	What methods have been used to analyse the information and figures that have been obtained?	[ , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ]
Q	What are the key aspects of near misses in the construction industry that have been of interest to the researchers?	[ , , , , , , , , , , , , ]

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Woźniak, Z.; Hoła, B. Analysing Near-Miss Incidents in Construction: A Systematic Literature Review. Appl. Sci. 2024 , 14 , 7260. https://doi.org/10.3390/app14167260

Woźniak Z, Hoła B. Analysing Near-Miss Incidents in Construction: A Systematic Literature Review. Applied Sciences . 2024; 14(16):7260. https://doi.org/10.3390/app14167260

Woźniak, Zuzanna, and Bożena Hoła. 2024. "Analysing Near-Miss Incidents in Construction: A Systematic Literature Review" Applied Sciences 14, no. 16: 7260. https://doi.org/10.3390/app14167260

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Understanding Systematic Risk

Systematic risk vs. unsystematic risk, systematic risk example, the bottom line.

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Systematic Risk: Definition and Examples

James Chen, CMT is an expert trader, investment adviser, and global market strategist.

Pete Rathburn is a copy editor and fact-checker with expertise in economics and personal finance and over twenty years of experience in the classroom.

Investopedia / Julie Bang

Systematic risk refers to the risk inherent to the entire market. Systematic risk, also known as undiversifiable risk, volatility risk, or market risk, affects the overall market, not just a particular stock or industry.

Key Takeaways

Systematic risk is inherent to the market as a whole, reflecting the impact of economic, geopolitical, and financial factors.
This type of risk is distinguished from unsystematic risk, which impacts a specific industry or security.
Systematic risk is largely unpredictable and generally viewed as being difficult to avoid.
Investors can somewhat mitigate the impact of systematic risk by building a diversified portfolio.

Systematic risk is both unpredictable and impossible to completely avoid. It cannot be mitigated through diversification, only through hedging or by using the correct asset allocation strategy.

Systematic risk underlies other investment risks, such as industry risk. For example, if an investor has placed too much emphasis on cybersecurity stocks, it is possible to diversify by investing in a range of stocks in other sectors, such as healthcare and infrastructure.

However, systematic risk incorporates interest rate changes, inflation, recessions, and wars, among other major changes. Shifts in these domains can affect the entire market and cannot be mitigated by changing positions within a portfolio of public equities .

To help manage systematic risk, investors should ensure that their portfolios include a variety of asset classes , such as fixed income, cash, and real estate, each of which will react differently in the event of a major systematic change. An increase in interest rates , for example, will make some new-issue bonds more valuable while causing some company stocks to decrease in price as investors perceive executive teams to be cutting back on spending. In the event of an interest rate rise, ensuring that a portfolio incorporates ample income-generating securities will mitigate the loss of value in some equities.

The opposite of systematic risk is unsystematic risk , which affects a very specific group of securities or an individual security. Unsystematic risk can be mitigated through diversification . While systematic risk can be thought of as the probability of a loss that is associated with the entire market or a segment thereof, unsystematic risk refers to the probability of a loss within a specific industry or security.

If you want to know how much systematic risk a particular security, fund, or portfolio has, you can look at its beta , which measures how volatile that investment is compared to the overall market. A beta of greater than one means the investment has more systematic risk (i.e., higher volatility ) than the market, while less than one means less systematic risk (i.e., lower volatility) than the market. A beta equal to one means the investment carries the same systematic risk as the market.

Systematic risk is different from systemic risk , which is the risk that a specific event can cause a major shock to the system.

The Great Recession also provides an example of systematic risk. Anyone who was invested in the market in 2008 saw the values of their investments change drastically due to this economic event. The Great Recession affected asset classes in different ways, as riskier securities (e.g., those that were more leveraged ) were sold off in large quantities, while simpler assets , such as U.S. Treasury bonds, became more valuable.

What is Unsystematic Risk?

The opposite of systematic risk is unsystematic risk, which affects a very specific group of securities or an individual security. Unsystematic risk can be mitigated through diversification. While systematic risk can be thought of as the probability of a loss that is associated with the entire market or a segment thereof, unsystematic risk refers to the probability of a loss within a specific industry or security.

How Can an Investor Manage Systematic Risk?

While systematic risk is both unpredictable and impossible to completely avoid, investors can manage it by ensuring that their portfolios include a variety of asset classes, such as fixed income, cash, and real estate, each of which will react differently to an event that affects the overall market. For example, an increase in interest rates will make some new-issue bonds more valuable, while causing some company stocks to decrease in value. Making sure that a portfolio incorporates ample income-generating securities will mitigate the loss of value in some equities.

What’s the Relationship Between Beta and Systematic Risk?

An investor can identify the systematic risk of a particular security, fund, or portfolio by looking at its beta. Beta measures how volatile that investment is compared to the overall market. A beta of greater than one means the investment has more systematic risk than the market, while less than one means less systematic risk than the market. A beta equal to one means the investment carries the same systematic risk as the market.

Systematic risk refers to the risks inherent in an entire market or economy rather than being specific to a particular company or industry—known as inherent risks . Systematic risk is also known as market risk or undiversifiable risk and can arise from factors such as inflation, recessions, war, changes in interest rates, fluctuations in currency exchange rates, natural disasters, and other macroeconomic events that impact the market as a whole.

Systematic risk can be mitigated through diversification, but the risk would still affect all investments in a particular market or economy. As a result, investors must be aware of the potential for systematic risk when making investment decisions and take steps to manage this risk through strategies such as asset allocation and risk management .

Knowledge at Wharton, Wharton School, University of Pennsylvania. “ The Causes of Systemic Risk—and Ways to Prevent Them .”

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Systematic Review
A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer. Example: Systematic review. In 2008, Dr. Robert Boyle and his colleagues published a systematic review in ...
Systematic review
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. [1] A systematic review extracts and interprets data from published studies on the topic (in the scientific literature), then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based ...
1.2.2 What is a systematic review?
A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made (Antman ...
Systematic reviews: Structure, form and content
Topic selection and planning. In recent years, there has been an explosion in the number of systematic reviews conducted and published (Chalmers & Fox 2016, Fontelo & Liu 2018, Page et al 2015) - although a systematic review may be an inappropriate or unnecessary research methodology for answering many research questions.Systematic reviews can be inadvisable for a variety of reasons.
Systematic Review
A systematic review is a type of review that uses repeatable methods to find, select, and synthesise all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer. Example: Systematic review. In 2008, Dr Robert Boyle and his colleagues published a systematic review in ...
What is a Systematic Review?
an explicit, reproducible methodology. a systematic search that attempts to identify all studies that would meet the eligibility criteria. an assessment of the validity of the findings of the included studies, for example through the assessment of the risk of bias. a systematic presentation, and synthesis, of the characteristics and findings of ...
What is a Systematic Review (SR)?
Systematic Reviews in the Social Sciences by Roberts, H., & Petticrew, M. Such diverse thinkers as Lao-Tze, Confucius, and U.S. Defense Secretary Donald Rumsfeld have all pointed out that we need to be able to tell the difference between real and assumed knowledge. The systematic review is a scientific tool that can help with this difficult task.
What are systematic reviews?
Cochrane evidence, including our systematic reviews, provides a powerful tool to enhance your healthcare knowledge and decision making. This video from Cochrane Sweden explains a bit about how we create health evidence and what Cochrane does. Search our Plain Language Summaries of health evidence. Learn more about Cochrane and our work.
What are systematic reviews?
Sometimes systematic reviews ask a broad research question, and one strategy to achieve this is the use of several focussed sub-questions each addressed by sub-components of the review. Another strategy is to develop a map to describe the type of research that has been undertaken in relation to a research question. Some maps even describe over ...
Systematic Reviews and Meta-Analysis: A Guide for Beginners
Systematic reviews involve the application of scientific methods to reduce bias in review of literature. The key components of a systematic review are a well-defined research question, comprehensive literature search to identify all studies that potentially address the question, systematic assembly of the studies that answer the question, critical appraisal of the methodological quality of the ...
How to Do a Systematic Review: A Best Practice Guide for Conducting and
Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question.
Introduction to systematic review and meta-analysis
A systematic review collects all possible studies related to a given topic and design, and reviews and analyzes their results [ 1 ]. During the systematic review process, the quality of studies is evaluated, and a statistical meta-analysis of the study results is conducted on the basis of their quality. A meta-analysis is a valid, objective ...
Guides: Systematic Review: What is a systematic review?
A systematic review is an authoritative account of existing evidence using reliable, objective, thorough and reproducible research practices. It is a method of making sense of large bodies of information and contributes to the answers to questions about what works and what doesn't. Systematic reviews map areas of uncertainty and identify where ...
What is a Systematic Review?
Definition and Elements. A systematic review is a comprehensive literature search that tries to answer a focused research question using existing research as evidence. Elements of a Systemic Review: Research team: including two independent screeners, a tie-breaker, librarian, and statistician;
What is a systematic review?
A high-quality systematic review is described as the most reliable source of evidence to guide clinical practice. The purpose of a systematic review is to deliver a meticulous summary of all the available primary research in response to a research question. A systematic review uses all the existing research and is sometime called 'secondary research' (research on research). They are often ...
CDC Library
Several CDC librarians have special training in conducting literature searches for systematic reviews. Literature searches for systematic reviews can take a few weeks to several months from planning to delivery. Fill out a search request form or contact the Stephen B. Thacker CDC Library by email [email protected] or telephone 404-639-1717.
UVM Libraries Research Guides: Systematic Reviews: What is a Systematic
Definition of Systematic Review. "A systematic review attempts to identify, appraise, and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias, in order to produce more reliable findings ...
Easy guide to conducting a systematic review
A systematic review is a type of study that synthesises research that has been conducted on a particular topic. Systematic reviews are considered to provide the highest level of evidence on the hierarchy of evidence pyramid. Systematic reviews are conducted following rigorous research methodology. To minimise bias, systematic reviews utilise a ...
Evidence Synthesis and Systematic Reviews
Definition: A systematic review is a summary of research results (evidence) that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue.It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and errors. When to use: If you want to identify, appraise, and synthesize all ...
PDF Undertaking a Systematic Review: What You Need to Know
Systematic Review Components. Starts with a clearly articulated question. Uses explicit, rigorous methods to identify, critically appraise, and synthesize relevant studies. Appraises relevant published and unpublished evidence for validity before combining and analyzing data. Reports methodology, studies included in the review, and conclusions ...
Systematic Reviews and Meta-analysis: Understanding the Best Evidence
Systematic reviews can also demonstrate where knowledge is lacking. This can then be used to guide future research. Systematic reviews are usually carried out in the areas of clinical tests (diagnostic, screening, and ... The steps undertaken in evaluating the study quality are early definition of study quality and criteria, setting up a good ...
What is a Systematic Review (SR)? » CEBMa
What is a Systematic Review (SR)? Evidence summaries come in many forms. One of the best-known types is the conventional literature review, which provides an overview of the relevant literature published on a topic. However, a conventional literature review's trustworthiness is often low: clear criteria for inclusion are often lacking ...
PDF A step-by-step guide
Systematic Review. High-quality evidence can make a real difference for actual people. systematic reviews are central to finding the answers to these important clinical questions. Systematic reviews are highly structured and follow a standard process. The process can be broken down into a series of smaller and more manageable steps.
(PDF) What are Systematic Reviews?
to provide an exhaustive summary of current evidence relevant to a research question. For example, systematic. reviews ofrandomized controlled trials are an important way of informing evidence ...
Effectiveness of biofeedback on blood pressure in patients with
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Analysing Near-Miss Incidents in Construction: A Systematic ...
The construction sector is notorious for its high rate of fatalities globally. Previous research has established that near-miss incidents act as precursors to accidents. This study aims to identify research gaps in the literature on near-miss events in construction and to define potential directions for future research. The Scopus database serves as the knowledge source for this study. To ...
Systematic Risk: Definition and Examples
Systematic risk is the risk inherent to the entire market or market segment . Systematic risk, also known as "undiversifiable risk," "volatility," or "market risk," affects the overall ...

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Easy guide to conducting a systematic review

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