What STROBE covers
STROBE stands for Strengthening the Reporting of Observational Studies in Epidemiology. It is a checklist and reporting guideline for the three main observational designs: cohort, case-control, and cross-sectional studies. Unlike a randomized trial, an observational study does not assign exposures, so STROBE focuses on describing how participants were selected, measured, and analyzed.
The participant flow diagram tracks numbers at each stage: those eligible, those included, those examined, and those lost to follow-up. It is the observational analogue of the CONSORT flow diagram used for randomized controlled trials.
Why participant flow matters in observational research
Observational studies are vulnerable to selection bias and attrition. A clear flow diagram lets readers see where participants dropped out and whether the analyzed sample still represents the population enrolled. Large or uneven losses to follow-up can distort associations between exposure and outcome.
By standardizing what is reported, STROBE helps readers and meta-analysts judge the internal validity of studies that cannot rely on randomization to balance confounders.