Water resources management decision support system is the application and development of decision support system in the field of water resources. It is a human-computer interaction system developed for the decision-making characteristics of water resources problems. It uses computer and corresponding software (including artificial intelligence, expert system and other technologies) to complete the functions of data extraction, logical reasoning, information processing and management decision-making. It can not only help decision-makers to understand the current situation of water resources in time, but also provide more comprehensive, scientific and reasonable integrated management programs for decision-makers to improve the efficiency and reliability of decision-making. This review elucidates and analyzes the current application trends and innovative advancements of Decision Support Systems (DSS) in water resources management (especially in groundwater management) domestically and internationally. At the same time, the paper summarizes prevalent issues existing in the development and application of decision support system. It is pointed out that the lack of basic data and unified standards, the lack of reliability of data-driven decision-making, the single function of decision support system, the lack of integrity of decision-making participation, the poor reusability and scalability of the system, and the lack of intelligence are the bottlenecks that need to be broken through in the application and development of decision support system in the field of groundwater resources management. Furthermore, the paper conducts an analysis and projection of its future trajectory in close consideration of the challenges currently confronting water resources management. It is underscored that standardization, integration, modularization, and intelligentization represent the prospective directions for the development of water resource decision support systems. These directions are envisioned to furnish some theoretical support for the establishment of comprehensive regional water resource decision support systems in the future.