Healthy Skepticism Library item: 13635

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ.
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
BMJ 2008 Apr 26; 336:(7650):924
http://www.bmj.com/cgi/content/extract/336/7650/924?etoc

Abstract:

Guidelines are inconsistent in how they rate the quality of evidence and the strength of recommendations. This article explores the advantages of the GRADE system, which is increasingly being adopted by organisations worldwide

Summary points

Failure to consider the quality of evidence can lead to misguided recommendations; hormone replacement therapy for post-menopausal women provides an instructive example

High quality evidence that an intervention’s desirable effects are clearly greater than its undesirable effects, or are clearly not, warrants a strong recommendation

Uncertainty about the trade-offs (because of low quality evidence or because the desirable and undesirable effects are closely balanced) warrants a weak recommendation

Guidelines should inform clinicians what the quality of the underlying evidence is and whether recommendations are strong or weak

The Grading of Recommendations Assessment, Development and Evaluation (GRADE ) approach provides a system for rating quality of evidence and strength of recommendations that is explicit, comprehensive, transparent, and pragmatic and is increasingly being adopted by organisations worldwide

Guideline developers around the world are inconsistent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face . . .

Box 1 Advantages of GRADE over other systems

What is “quality of evidence” and why is it important?

How should guideline developers alert clinicians to quality of evidence?

What is “strength of recommendation” and why is it important?

What makes a good grading system?

How does the GRADE system classify quality of evidence?

Box 2 Quality of evidence and definitions

How does the GRADE system consider strength of recommendation?

guyatt@mcmaster.ca