Systematic Review Process Diagram

Welcome to the interactive process map.

This tool was developed by the St. Michael’s hospital KT program. We have a defined and rigorous process for all our systematic reviews.

This process map takes you through the steps to conduct a systematic review. Click on the individual steps for more information about each step.

Systematic review and network meta-analysis process diagram
Develop Research Question using PICOST Determine Eligibility Criteria Plan Literature Search Perform Literature Search Starting a Systematic Review Level 1 Screening: Titles and Abstracts Level 2 Screening: Full Text Articles Develop Data Abstraction Form Abstract Data Critical Appraisal and Assessment Summarize Study and Patient Characteristics Synthesize the Results Presentation of Results Prepare Manuscript End-of-Review Knowledge Translation Systematic Review Protocol Development

Plan Literature Search

• Ask a librarian to develop the search to ensure relevant keywords and search strategies are used for a comprehensive search; peer-review by another librarian


Additional Resources

Cochrane Handbook Section 2.6.4: Designing search strategies

PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. McGowan J et al. 2016. J Clin Epidemiol.

Level 1 Screening: Titles and Abstracts

• Pilot test to assess accuracy and usability of eligibility criteria developed for the Level 1 screening process with a small sample of studies

• Screening of all titles and abstracts by two independent reviewers. Conflicts usually resolved by discussion


Additional Resources

Cochrane Handbook Section 2.7.2: Selecting studies 

Centre for Reviews and Dissemination: 1.3.2 Study Selection

Identifying relevant studies for systematic reviews. Dickersin et al. 1994. BMJ.

The science of reviewing research. Oxman et al. 1993. Ann N Y Acad Sci.

The art and science of study identification: a comparative analysis of two systematic reviews. Rosen et al. 2016. BMC Med Res Methodol.

Develop Data Abstraction Form

Critical Appraisal and Assessment

• Critical appraisal is the assessment of evidence by systematically reviewing its relevance, validity, and results.


Additional Resources

Cochrane Handbook Section 2.12.2: Assessing the quality of a body of evidence

Cochrane Handbook Section 2.8: Assessing risk of bias in included studies

Centre for Reviews and Dissemination: 1.3.4 Quality Assessment

Critical Appraisals Skills Programme (CASP)

Cochrane Effective Practice and Organisation of Care Group

Appraising qualitative research for inclusion in systematic reviews: a quantitative and qualitative comparison of three methods. Dixon WM et al.  2007. J Health Serv Res Policy.

Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Sanderson S et al. 2007. Int J Epidemiol.

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Higgins JP et al. 2011. BMJ.

The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Wells G et al. 2000.

AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Shea BJ et al. 2009. J Clin Epidemiol.

Few systematic reviews exist documenting the extent of bias: a systematic review. Tricco AC et al. 2008. J Clin Epidemiol.

AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in health care. Brouwers MC et al. 2010. J Clin Epidemiol. 

ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Sterne et al. 2016. BMJ. 

GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Guyatt et al. 2011. J Clin Epidemiol.

Summarize Study and Patient Characteristics

• Use tables and text to describe study and patient characteristics


Additional Resources

Cochrane Handbook Section Characteristics of included studies tables