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AMSTAR 2 Checklist for Appraising Systematic Reviews

Appraise systematic reviews with the 16 AMSTAR 2 items. The overall confidence rating (high, moderate, low or critically low) is suggested from the critical domains, and you can download plots for umbrella reviews.

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Domains and how to use them
  1. 1: PICO components in the question and inclusion criteria
  2. 2: Protocol established in advance; deviations justifiedcritical
  3. 3: Choice of study designs explained
  4. 4: Comprehensive literature searchcritical
  5. 5: Study selection in duplicate
  6. 6: Data extraction in duplicate
  7. 7: List of excluded studies with justificationcritical
  8. 8: Included studies described in adequate detail
  9. 9: Satisfactory risk-of-bias assessment of included studiescritical
  10. 10: Funding sources of included studies reported
  11. 11: Appropriate meta-analysis methodscritical
  12. 12: Impact of risk of bias on the meta-analysis assessed
  13. 13: Risk of bias considered when interpreting resultscritical
  14. 14: Heterogeneity explained and discussed
  15. 15: Publication bias investigated and discussedcritical
  16. 16: Conflicts of interest and review funding reported

Answer the signalling questions in the official tool, then record your judgements here: AMSTAR 2 checklist (amstar.ca).

Study12345678910111213141516Confidence

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Critical items: 2, 4, 7, 9, 11, 13 and 15. High: no or one non-critical weakness. Moderate: more than one non-critical weakness. Low: one critical flaw. Critically low: more than one critical flaw. A 'No' counts as a flaw or weakness; 'Partial yes' does not. The scheme is advisory: you can adjust which items are critical for your topic and override the rating.

Summary plot

Traffic light plot

Study12345678910111213141516ConfidenceExample review 1+++±+++++×++++++HExample review 2+±×±+×±++×+×++++MExample review 3+××±++×±±×+++××+CL1: PICO components in the question and inclusion criteria2: Protocol established in advance; deviations justified (critical domain)3: Choice of study designs explained4: Comprehensive literature search (critical domain)5: Study selection in duplicate6: Data extraction in duplicate7: List of excluded studies with justification (critical domain)8: Included studies described in adequate detail9: Satisfactory risk-of-bias assessment of included studies (critical domain)10: Funding sources of included studies reported11: Appropriate meta-analysis methods (critical domain)12: Impact of risk of bias on the meta-analysis assessed13: Risk of bias considered when interpreting results (critical domain)14: Heterogeneity explained and discussed15: Publication bias investigated and discussed (critical domain)16: Conflicts of interest and review funding reported+Yes±Partial yes×No–No meta-analysisHHighMModerateLLowCritically low

Summary plot

1. PICO components in the question and inclusion criteria100%2. Protocol established in advance; deviations justified33%33%33%3. Choice of study designs explained33%67%4. Comprehensive literature search100%5. Study selection in duplicate100%6. Data extraction in duplicate67%33%7. List of excluded studies with justification33%33%33%8. Included studies described in adequate detail67%33%9. Satisfactory risk-of-bias assessment of included studi…67%33%10. Funding sources of included studies reported100%11. Appropriate meta-analysis methods100%12. Impact of risk of bias on the meta-analysis assessed67%33%13. Risk of bias considered when interpreting results100%14. Heterogeneity explained and discussed67%33%15. Publication bias investigated and discussed67%33%16. Conflicts of interest and review funding reported100%Overall confidence33%33%33%0%25%50%75%100%YesPartial yesNoNo meta-analysisHighModerateLowCritically low
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How to Use the AMSTAR 2 Checklist

  1. 1

    Answer the official signalling questions

    Use the linked tool document for each study or result.

  2. 2

    Record your judgements

    One row per study, one column per domain; the overall judgement is suggested for you.

  3. 3

    Download the figures

    Traffic light and summary plots as PNG or SVG, plus a CSV of your table.

How AMSTAR 2 works

AMSTAR 2 is a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. It has 16 items answered yes, partial yes (for some items) or no.

Seven items are considered critical: protocol registration (2), the literature search (4), justification of excluded studies (7), risk of bias assessment (9), meta-analysis methods (11), considering risk of bias when interpreting results (13) and publication bias (15).

AMSTAR 2 is not intended to produce a score. Instead, overall confidence is rated from the number of critical flaws and non-critical weaknesses.

How it is calculated

Sources

AMSTAR 2 Checklist: FAQ

Can I change which items are critical?

Yes. The developers note that the critical domains may differ by topic; state your choices in your methods and use the override where needed.

Is AMSTAR 2 used for umbrella reviews?

Yes, it is widely used to appraise the systematic reviews included in umbrella reviews and overviews of reviews.

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