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Year : 2019  |  Volume : 13  |  Issue : 5  |  Page : 31-34

The STROBE guidelines

Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Building, University of Malta, Msida, Malta

Correspondence Address:
Dr. Sarah Cuschieri
Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Building, University of Malta, Msida MSD 2080
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.SJA_543_18

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Date of Web Publication21-Feb-2019


An observational study is a type of epidemiological study design, which can take the form of a cohort, a case–control, or a cross-sectional study. When presenting observational studies in manuscripts, an author needs to ascertain a clear presentation of the work and provide the reader with appropriate information to enable critical appraisal of the research. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines were created to aid the author in ensuring high-quality presentation of the conducted observational study. The original articles publishing the STROBE guidelines together with their bibliographies were identified and thoroughly reviewed. These guidelines consist of 22 checklist items that the author needs to fulfil before submitting the manuscript to a journal. The STROBE guidelines were created to aid the authors in presenting their work and not to act as a validation tool for the conducted study or as a framework to conduct an observational study on. The authors complying with these guidelines are more likely to succeed in publishing their observational study work in a journal.

Keywords: Data reporting; epidemiology; observational studies; publishing; research design

How to cite this article:
Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019;13, Suppl S1:31-4

How to cite this URL:
Cuschieri S. The STROBE guidelines. Saudi J Anaesth [serial online] 2019 [cited 2021 Sep 16];13, Suppl S1:31-4. Available from:

  Introduction Top

Different epidemiological study designs are available and are adopted by a researcher depending on the research question at hand. An observational study is one type of epidemiological study design, which can be in the form of a cohort, a case–control, or a cross-sectional study. This type of study design (observational) is defined as a nonexperimental research, where the researcher observes a particular environmental behavior without artificially controlling the environment under study. To ascertain high-quality reporting of observational studies, the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines were developed following a collaborative initiative of epidemiologists, methodologists, statisticians, researchers, and journal editors in 2004.[1] These guidelines were created to aid in the presentation of the conducted observational study to ensure adequate reporting (what was planned, done, found, and concluded) as well as assessment of the strengths and weaknesses of the study.[1],[2] Such study information is of vital importance in a manuscript since this will determine whether the established results can be included in systemic reviews later on.[3],[4] Furthermore, the STROBE guidelines enable the journal's editor, reviewers, and the readers to critically appraise the study.[1]

  The STROBE Guidelines Top

The aim of the STROBE guidelines was to provide a readily available checklist to ensure a clear presentation of what was planned and conducted in an observational study. These studies are set out to investigate the associations between an exposure and a health outcome. In no way were these guidelines established to provide a methodological framework for conducting an observational study.[1] Nor were the guidelines developed as an instrument for quality evaluation of observational research.[2] Furthermore, the guidelines were not aimed to bring forward standardization of manuscripts but rather to encourage the production of interesting and narrative articles while maintaining transparency.[5]

  The Strobe Checklist Top

A total of 22 checklist items contribute to the STROBE guidelines. Eighteen items are common to all the three observational designs, that is, cohort, cross-sectional, and case–control studies. However, the remaining four checklist items (items number 6, 12, 14, and 15) have specific variations according to the study design. [Table 1] exhibits the STROBE guidelines as published by Vandenbroucke et al.[1] The following is an abbreviated explanation of the checklist items.
Table 1: STROBE guidelines

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  Item 1: Title and Abstract Top

The adopted study design should be part of the manuscript title to ensure correct indexing of the manuscript in electronic databases. Indexing of the published manuscript is of utmost importance to ensure visibility of a researcher's work and increase the citation potential of the published manuscript. Citation of published manuscripts is imperative for the enhancement of the researcher's research metrics and for increasing the prestigious acknowledgement of the researcher and his or her work within the scientific community.[6] The abstract should include a brief summary of the study and present only information found within the actual body of the manuscript.

  Items 2 and 3: Introduction Top

The introduction should consist of background information that will set the scene for the study and the objective of the study. The objective states the researcher's intentions for conducting the study and potential hypotheses that may arise from such work.

  Items 4–12: Methods Top

The methods section should provide a clear description of the study design at an early stage. This will enable the reader to understand the basis of the study and be able to critically appraise the study's methodology. The STROBE guidelines do not allow the use of the words “prospective” or “retrospective” or “concurrent” or “historical,” but rather encourage the researcher to describe the actual methodology.[1]

Information on the tools of measurement, setting, and locations should be reported to enhance the reader's understanding of the study's results. The reporting of the participants' recruitment procedure will vary depending on the type of observation design being conducted. Therefore, it is important that the researcher is knowledgeable about the epidemiological methodological design for each different observational study (i.e., cohort, case–control, or cross-sectional, respectively).

All the variables considered for the descriptive and statistical analysis of the study need to be noted down within the methods section. This also includes the reporting of any specific cut-off points implemented during the analysis. It is essential that any exposures, confounders, or outcomes measurements are accounted for and reported for the reader to critically appraise the study's reliability and validity. The inclusion and exclusion criteria and methods to overcome any potential bias should be noted down as well.

The method used to establish the study size needs to be reported along with the confidence intervals considered. This is essential for the reader to ascertain whether sufficient statistical precision has been attained in the study.[1]

The reporting of statistical analysis will vary depending on the study design (i.e., cohort, case–control, or cross-sectional). However, it is important that all statistical methods and adjustments for potential confounders or missing data are noted down clearly.

  Items 13–17: Results Top

The results section should give an in-depth account of the response rate and the description of the study population along with the main descriptive and analytical results. The information provided will depend on the type of observational design (i.e., cohort, case–control, or cross-sectional) followed by the researcher and the corresponding statistical analysis performed.

  Items 18–21: Discussion Top

The discussion should address all the central issues of the study including the validity of the study. The objective/s of the study should be kept in mind while discussing the findings. Comparisons to already published literature are essential. It may be appropriate for the discussion section to be subdivided into different sections to enable better interpretation of the study findings. The researcher should provide an objective assessment of the findings and avoid overinterpretations. Potential confounder effects that might have had an effect on the results and associations obtained in the study should be considered. Therefore, it is imperative to note down potential limitations faced by the study, while noting any bias that might have been present. Furthermore, researchers have to keep in mind that causality of a particular outcome cannot be established in most study designs, unless a longitudinal cohort study has been conducted. Therefore, this fact needs to be acknowledged during the discussion and may act as a study limitation for certain study designs. Study limitations go hand in hand with recommendations for further research to validate the study or further establish associations that were revealed by the study.

  Item 22: Funding and Sponsorship Top

The source of funding and the role of the funders in the study are essential pieces of information that are required at the end of the article. This is accompanied with any conflict of interest of both the author/s and the funders.

  Conclusion Top

A substantial number of journals are requesting authors to follow the STROBE guidelines before submitting their observational-study-inspired manuscript. Having a thorough understanding of the STROBE guidelines is therefore becoming a requisite for authors who wish to conduct and publish an observational study. These guidelines have been formulated as an aid to authors to enable them to construct an adequately presented manuscript that allows the reader to fully comprehend and critically appraise the manuscript.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. PLoS Med 2007;4:e297.  Back to cited text no. 1
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007;335:806-8.  Back to cited text no. 2
Jüni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ 2001;323:42-6.  Back to cited text no. 3
Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ 1998;316:140-4.  Back to cited text no. 4
Schriger DL. Suggestions for improving the reporting of clinical research: The role of narrative. Ann Emerg Med 2005;45:437-43.  Back to cited text no. 5
Cuschieri S. WASP (Write a scientific paper): Understanding research metrics. Early Hum Dev 2018;118:67-71.  Back to cited text no. 6


  [Table 1]


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   The STROBE Guide...
  The Strobe Checklist
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