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PRISMA 2020 流程圖

關於 PRISMA 流程圖

PRISMA 2020 流程圖（Page MJ 等人，BMJ 2021;372:n71）是每篇發表於 BMJ、Lancet、JAMA、Cochrane、JBI 及 200+ 其他期刊的系統性回顧、統合分析和範疇性回顧中必備的圖表。它是一個單一、固定的四列圖表——識別 → 篩選 → 合適性評估 → 納入——每個方框都有記錄計數，並附有平行的「排除」側方框。

從概念上看它是流程圖，但佈局、必填的 n = 欄位和雙管道變體是規定的。Schematex 將 prisma 實作為獨立的、有主見的引擎，讓作者只需填寫計數和排除原因，圖表就能正確建構——不可能意外遺漏計數或弄錯階段順序。規格：28-PRISMA-STANDARD.md。

與流程圖不同：通用流程圖沒有強制階段、記錄計數、排除側方框或雙管道合流的概念。只要圖表是 PRISMA 回顧流程，就應使用 prisma。

prisma·§ —
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Effect of exercise on chronic low-back pain — SR PRISMA 2020 flow diagram (2020-single, systematic-review) — 7 boxes, 6 arrows Effect of exercise on chronic low-back pain — SR Identification Screening Included Identification of studies via databases and registers Records identified from: PubMed (n = 600) Embase (n = 450) Cochrane (n = 184) Web of Science (n = 184) Total (n = 1,418) Records removed before screening Duplicate records removed (n = 318) Records screened n = 1,100 Records excluded n = 870 irrelevant title (n = 750) non-English (n = 120) Reports assessed for eligibility n = 230 Reports excluded, with reasons: n = 195 wrong population (n = 80) wrong intervention (n = 60) wrong outcome (n = 55) Studies included in review Studies included (n = 35) Reports of included studies (n = 38)
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1. 第一個圖表

最基本的是四個階段方框。計數為必填項；解析器會拒絕排列缺少總計的圖表。

prisma

identification:
  databases:
    n: 1000

screening:
  records-screened: 900
  excluded:
    n: 600

eligibility:
  full-text-assessed: 300
  excluded:
    n: 250

included:
  studies: 50

縮排有意義——每層兩個空格，與 genogram 和 SLD 相同。第一個非空白行必須是 prisma。註解使用 # 或 //。

2. 元資料行

在階段方框之前，於頂層寫入 key: value 行：

prisma
mode: 2020-single
kind: systematic-review
title: My review
validate-counts: warn
鍵值預設值說明
mode2020-single · 2020-dual · 20092020-single單欄或雙欄（「其他方法」）欄。
kindsystematic-review · scoping-review · ipd · nmasystematic-review切換階段詞彙（見 §6）。
title字串—顯示在圖表上方。
validate-countswarn · strict · offwarn算術檢查（見 §7）。
directionTB / TDTBPRISMA 依標準為垂直排列；水平方向會被拒絕。

3. 識別

identification: 區塊包含一個 databases: 子區塊（必填）和一個可選的 other: 子區塊（雙管道模式）。

identification:
  databases:
    n: 1418
    sources: PubMed=600, Embase=450, Cochrane=184
    duplicates-removed: 318
    ineligible-automation: 0
    other-removed: 0
  • n: — 識別到的記錄總數（必填）。
  • sources: — 名稱=計數 配對，以逗號分隔。渲染為縮排的細項。含有空格或標點符號的名稱可加引號："Web of Science"=184。
  • duplicates-removed:、ineligible-automation:、other-removed: — 可選的移除計數。若有任何一項存在，它們會在右欄渲染為獨立的**「篩選前移除的記錄」**方框，並以水平箭頭連接。

大數字可使用逗號：n: 1,418 與 n: 1418 相同。

4. 篩選與合適性評估

兩個階段都有一個主計數和一個 excluded: 區塊。排除區塊有自己的 n: 和可選的 reasons: 細項。

screening:
  records-screened: 1100
  excluded:
    n: 870
    reasons: irrelevant title=750, non-English=120
  reports-sought: 226        # optional
  reports-not-retrieved: 12  # optional

eligibility:
  full-text-assessed: 230
  excluded:
    n: 195
    reasons: wrong population=80, wrong intervention=60, wrong outcome=55

reasons: 為 名稱=計數 配對。若列出超過 8 項，渲染器會以降序排列並將尾部匯總為 其他（n = …），使側方框保持可讀。

5. 納入

included:
  studies: 35
  reports: 38          # one study may yield several reports
  participants: 28741  # PRISMA-IPD only

studies: 為必填。reports: 和 participants: 為可選的額外計數行。

6. 雙管道與回顧類型

雙管道 — PRISMA 2020 更新新增了第二個「透過其他方法識別」欄（引文搜尋、手動搜尋、專家推薦）。加入 other: 區塊後，兩欄透過 Y 形接頭匯入篩選階段。

prisma
mode: 2020-dual

identification:
  databases:
    n: 1234
    duplicates-removed: 254
  other:
    n: 56
    sources: citation-search=30, hand-search=20, expert-recommendation=6

screening:
  records-screened: 1036
  excluded:
    n: 810

eligibility:
  full-text-assessed: 226
  excluded:
    n: 195

included:
  studies: 31

範疇性回顧 — kind: scoping-review 將「studies」換成「sources of evidence」，並依照 Tricco 等人 2018 年的標準重新標記各階段，幾何結構不變。

更新性回顧 — 可選的 previous-studies: 區塊在識別部分上方繪製一個虛線方框並連入其中：

previous-studies:
  n: 19
  sources: previous review=19

7. 計數算術驗證

使用 validate-counts: warn（預設）時，引擎會檢查各階段的計數是否相符——例如 databases.n + other.n − duplicates-removed = records-screened，以及來源/原因細項是否加總等於其總計。不符時會在圖表下方渲染一個小警告（也在 SVG 的 <desc> 中顯示，供螢幕閱讀器使用）。

validate-counts: strict 會將不符情況轉為包含「偏差 N」訊息的解析錯誤。off 則完全跳過檢查。

8. 語法（EBNF）

prisma-document  = "prisma", { meta-line }, stage-block, { stage-block } ;
meta-line        = ("mode:" | "kind:" | "title:" | "review-id:" | "validate-counts:" | "direction:") value ;

stage-block      = previous-block | identification-block | screening-block | eligibility-block | included-block ;

previous-block       = "previous-studies:" , indent, "n:" int, [ "reports:" int ], { "sources:" pairs } ;
identification-block = "identification:" , indent,
                         "databases:" , indent, "n:" int, { "sources:" pairs },
                           [ "duplicates-removed:" int ], [ "ineligible-automation:" int ], [ "other-removed:" int ],
                         [ "other:" , indent, "n:" int, { "sources:" pairs } ] ;
screening-block      = "screening:" , indent, "records-screened:" int,
                         "excluded:" , indent, "n:" int, { "reasons:" pairs },
                         [ "reports-sought:" int ], [ "reports-not-retrieved:" int ] ;
eligibility-block    = "eligibility:" , indent, "full-text-assessed:" int,
                         "excluded:" , indent, "n:" int, { "reasons:" pairs } ;
included-block       = "included:" , indent, "studies:" int, [ "reports:" int ], [ "participants:" int ] ;

pairs            = pair, { "," pair } ;
pair             = (string | quoted) "=" int ;
int              = digit, { digit | "," } ;     (* commas stripped: 1,234 == 1234 *)

縮排為每層兩個空格。階段方框內的未知鍵為解析錯誤，使每個階段定義明確。

9. 標準合規性

遵循 PRISMA 2020 聲明（Page MJ, McKenzie JE, Bossuyt PM 等人。The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71）和 PRISMA2020 R 套件（Haddaway 等人 2022）的參考渲染器慣例。範疇性回顧詞彙遵循 PRISMA-ScR（Tricco 等人 2018）；參與者計數遵循 PRISMA-IPD（Stewart 等人 2015）。範本：prisma-statement.org/prisma-2020-flow-diagram。

相關範例

來自範例圖庫的即用情境：

prisma·§ PRISMA 2020 (Page et al., BMJ 2021;372:n71)
Effect of exercise on chronic low-back pain — SR PRISMA 2020 flow diagram (2020-single, systematic-review) — 7 boxes, 6 arrows Effect of exercise on chronic low-back pain — SR Identification Screening Included Identification of studies via databases and registers Records identified from: PubMed (n = 600) Embase (n = 450) Cochrane (n = 184) Web of Science (n = 184) Total (n = 1,418) Records removed before screening Duplicate records removed (n = 318) Records screened n = 1,100 Records excluded n = 870 irrelevant title (n = 750) non-English (n = 120) Reports assessed for eligibility n = 230 Reports excluded, with reasons: n = 195 wrong population (n = 80) wrong intervention (n = 60) wrong outcome (n = 55) Studies included in review Studies included (n = 35) Reports of included studies (n = 38)
PRISMA 2020 systematic review (single pipeline)
Canonical PRISMA 2020 flow diagram for a systematic review using the dedicated prisma engine — records identified across four databases, deduplicated, screened, assessed for eligibility, and included, with exclusion side-boxes and mandatory n = counts.
healthcare & social
prisma·§ PRISMA 2020 (Page et al., BMJ 2021;372:n71)
Effect of yoga on chronic back pain — SR PRISMA 2020 flow diagram (2020-dual, systematic-review) — 8 boxes, 7 arrows Effect of yoga on chronic back pain — SR Identification Screening Included Identification of studies via databases and registers Identification of studies via other methods Records identified from: PubMed (n = 600) Embase (n = 450) Cochrane (n = 184) Total (n = 1,234) Records removed before screening Duplicate records removed (n = 254) Identification of studies via other methods citation-search (n = 30) hand-search (n = 20) expert-recommendation (n = 6) Total (n = 56) Records screened n = 1,036 Reports sought for retrieval n = 226 Reports not retrieved (n = 12) Records excluded n = 810 duplicate (n = 120) irrelevant title (n = 560) non-English (n = 130) Reports assessed for eligibility n = 214 Reports excluded, with reasons: n = 191 wrong population (n = 80) wrong intervention (n = 60) wrong outcome (n = 51) Studies included in review Studies included (n = 23) Reports of included studies (n = 25)
PRISMA 2020 dual pipeline (databases + other methods)
PRISMA 2020 flow diagram in dual-pipeline mode — identification via databases and registers plus a second column for other methods (citation searching, hand searches, expert recommendations), merged into screening via a Y-junction.
healthcare & social

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關於 PRISMA 流程圖1. 第一個圖表2. 元資料行3. 識別4. 篩選與合適性評估5. 納入6. 雙管道與回顧類型7. 計數算術驗證8. 語法（EBNF）9. 標準合規性相關範例