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GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables |
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| Authors: | Guyatt Gordon Oxman Andrew D Akl Elie A Kunz Regina Vist Gunn Brozek Jan Norris Susan Falck-Ytter Yngve Glasziou Paul DeBeer Hans Jaeschke Roman Rind David Meerpohl Joerg Dahm Philipp Schünemann Holger J |
| Affiliation: | a Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8N 3Z5, Canada b Department of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada c Norwegian Knowledge Centre for the Health Services, St. Olavs plass, 0130 Oslo, Norway d Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland e Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR 97239-3098, USA f Division of Gastroenterology, Case and VA Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA g Bond University, Gold Coast, Australia h Dutch Association of Nursing-home Specialists, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands i Harvard Medical School, UpToDate, Boston, MA, USA j German Cochrane Center, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, 79104 Freiburg, Germany k Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University Medical Center Freiburg, 79106 Freiburg, Germany l Department of Urology, University of Florida, College of Medicine, Gainesville, FL 3210, USA m Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA |
| Abstract: | This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect.Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating.Subsequent articles in this series will address GRADE’s approach to formulating questions, assessing quality of evidence, and developing recommendations. |
| Keywords: | GRADE systematic reviews clinical practice guidelines health technology assessment quality of evidence strength of recommendations |
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