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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration

      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.


      Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site ( should be helpful resources to improve reporting of observational research.


      In this explanatory and elaboration document Mattias Egger and colleagues provide the meaning and rationale of each checklist item on the STROBE Statement.

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      Most cited references 240

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      Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

       T Sipe,  D Rennie,  D Stroup (2000)
      Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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        Inference and missing data

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            Author and article information

            [1 ] Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
            [2 ] Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
            [3 ] Department of Medical Biometry and Medical Informatics, University Medical Centre, Freiburg, Germany
            [4 ] Cancer Research UK/NHS Centre for Statistics in Medicine, Oxford, United Kingdom
            [5 ] Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
            [6 ] University of Texas Health Science Center, San Antonio, United States of America
            [7 ] Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
            [8 ] Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, United States of America
            [9 ] Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, and University of Pittsburgh Cancer Institute, Pittsburgh, United States of America
            [10 ] Department of Social Medicine, University of Bristol, Bristol, United Kingdom
            Author notes
            * To whom correspondence should be addressed. E-mail: strobe@
            PLoS Med
            PLoS Medicine
            Public Library of Science (San Francisco, USA )
            October 2007
            16 October 2007
            : 4
            : 10
            07-PLME-RA-1056R1 plme-04-10-05
            Copyright: © 2007 Vandenbroucke et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. In order to encourage dissemination of the STROBE Statement, this article is freely available on the Web site of PLoS Medicine, and will also be published and made freely available by Epidemiology and Annals of Internal Medicine. The authors jointly hold the copyright of this article. For details on further use, see STROBE Web site (
            Pages: 27
            Research Article
            Public Health and Epidemiology
            Science Policy
            Editorial Policies (Including Conflicts of Interest)
            Research Methods
            Custom metadata
            Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, et al. (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med 4(10): e297. doi: 10.1371/journal.pmed.0040297



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