PRISMA guideline compliance is imperative for systematic review appraisal

Dear Editor,

A review entitled “Effect of Bisphosphonates on Bone Health in Adult Renal Transplant Patients: Beyond the First Year Posttransplant—A Systematic Review and Meta-Analysis” by Lip et al.¹ refers readers to a sample search strategy in the Supplemental Material online. However, the text in Figure 1 is provided in an unreadable format (Wingdings font).

Without knowing which keywords and/or subject headings were used to execute a systematic search, it is not possible to gauge how comprehensive it was and whether eligible studies may have been missed. At the peer review level, it may be appropriate to request a broader or otherwise revised search approach before the research is publication worthy. Otherwise, incomplete identification of relevant studies may result in bias and discrepancies between systematic reviews.^2,3 PRISMA guidelines, an evidence-based minimum set of items for reporting systematic reviews, instruct authors to present the full electronic search strategy for at least 1 database (PRISMA Checklist Item 8).⁴

It is also important for peer reviewers and readers to understand the process for selecting studies, including how references were screened (PRISMA Checklist Item 9)⁴. As the Institute of Medicine⁵ explains “[e]ven when the selection criteria are prespecified and explicit, decisions on including particular studies can be subjective (p 110).” Using a complete dual review approach, where 2 reviewers screen at both stages, has been shown to identify additional eligible studies at both the title/abstract and the full-text stage.⁶ It should be clear when reading a systematic review if best practices were followed, including the recommendation to have more than 1 reviewer screen studies for eligibility.^5,7,8

Journals and peer reviewers should ensure that authors of systematic reviews and meta-analyses are compliant with PRISMA guidelines. Adherence to reporting guidelines helps peer reviewers and readers by facilitating the critical appraisal of research using standardized checklists such as AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews).⁹ As the International Committee of Journal Medical Editors¹⁰ explains, “Journals are encouraged to ask authors to follow these guidelines because they help authors describe the study in enough detail for it to be evaluated by editors, reviewers, readers, and other researchers evaluating the medical literature.”¹⁰

Given that this review was conducted at the same institution as the author of this letter, I was able to communicate with the review authors and verify the search strategy.

Sincerely,

Sandra McKeown