Grading quality of evidence and strength of recommendations in clinical practice guidelines |
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| Authors: | J. L. Bro&# ek,E. A. Akl,P. Alonso-Coello,D. Lang,R. Jaeschke,J. W. Williams,B. Phillips,M. Lelgemann,A. Lethaby,J. Bousquet,G. H. Guyatt,H. J. Schü nemann,for the GRADE Working Group |
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| Affiliation: | Department of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy;;Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland;;Department of Medicine and Social and Preventive Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA;;Iberoamerican Cochrane Center, Servicio de Epidemiología Clínica y Salud Pública, Hospital de Sant Pau, Barcelona, Spain;;Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain;;Allergy/Immunology Section, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA;;Department of Medicine, McMaster University, Hamilton, ON, Canada;;Department of Internal Medicine and Psychiatry, Duke University and Durham VA Medical Center, Durham, NC, USA;;Centre for Reviews and Dissemination, University of York, York, UK;;HTA-Zentrum, Universität Bremen, Bremen, Germany;;School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand;;Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France;;Inserm UMR 780, France;;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada |
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| Abstract: | ![]()
The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system's conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three-part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel's confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence. |
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| Keywords: | clinical practice guidelines evidence based medicine grading |
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