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, Philippa Middleton, Dianne O'Connell & 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

1516 Citations (Scopus)

Abstract

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.

LanguageEnglish
JournalThe BMJ
Volume328
Issue number7454
Publication statusPublished - 19 Jun 2004

ASJC Scopus subject areas

  • Medicine(all)

Cite this

GRADE Working Group. / Grading quality of evidence and strength of recommendations. In: The BMJ. 2004 ; Vol. 328, No. 7454.
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GRADE Working Group 2004, 'Grading quality of evidence and strength of recommendations', The BMJ, vol. 328, no. 7454.

Grading quality of evidence and strength of recommendations. / GRADE Working Group.

In: The BMJ, Vol. 328, No. 7454, 19.06.2004.

Research output: Contribution to journalArticle

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AU - Best, Dana

AU - Briss, Peter A.

AU - Eccles, Martin

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AU - Flottorp, Signe

AU - Guyatt, Gordon H.

AU - Harbour, Robin T.

AU - Haugh, Margaret C.

AU - Henry, David

AU - Hill, Suzanne

AU - Jaeschke, Roman

AU - Leng, Gillian

AU - Liberati, Alessandro

AU - Magrini, Nicola

AU - Mason, James

AU - Middleton, Philippa

AU - Middleton, Philippa

AU - O'Connell, Dianne

AU - Oxman, Andrew D.

AU - Phillips, Bob

AU - Schünemann, Holger J.

AU - Edejer, Tessa Tan Torres

AU - Varonen, Helena

AU - Vist, Gunn E.

AU - Williams, John W.

AU - Zaza, Stephanie

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GRADE Working Group. Grading quality of evidence and strength of recommendations. The BMJ. 2004 Jun 19;328(7454).