Grading quality of evidence and strength of recommendations

GRADE Working Group, David Atkins, Dana Best, Peter A. Briss, Martin Eccles, Yngve Falck-Ytter, Signe Flottorp, Gordon H. Guyatt, Robin T. Harbour, Margaret C. Haugh, David Henry, Suzanne Hill, Roman Jaeschke, Gillian Leng, Alessandro Liberati, Nicola Magrini, James Mason, Philippa Middleton, Jacek Mrukowicz, Philippa Middleton & 8 others Andrew D. Oxman, Bob Phillips, Holger J. Schünemann, Tessa Tan Torres Edejer, Helena Varonen, Gunn E. Vist, John W. Williams, Stephanie Zaza

Research output: Contribution to journalArticle


Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.

JournalThe BMJ
Issue number7454
Publication statusPublished - 19 Jun 2004

ASJC Scopus subject areas

  • Medicine(all)

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