GRADE指南:Ⅳ.证据质量分级——研究的局限性(偏倚风险)

被引:28
作者
Gordon H.Guyatt
Andrew D.Oxman
Gunn Vist
Regina Kunz
Jan Brozek
Pablo Alonso-Coello
Victor Montori
Elie A.Akl
Ben Djulbegovic
Yngve Falck-Ytter
Susan L.Norris
John W.Williams Jr.
David Atkins
Joerg Meerpohl
Holger J.Schünemann
GRADE工作组
李幼平
杨晓妍
李鸿浩
李玲
机构
关键词
GRADE; 证据质量; 偏倚风险; 估计值的可信度; 盲法; 分配隐藏;
D O I
暂无
中图分类号
R-03 [];
学科分类号
1001 ;
摘要
在GRADE方法中,若多数相关证据来自高偏倚风险的研究,则起初被定为高质量证据的随机试验和低质量证据的观察性研究均有可能被降低质量等级。随机试验已确定的局限性包括:未进行分配隐藏、未实施盲法、未报告失访情况及未恰当考虑意向性治疗原则。最近提出的局限性包括:因明显获益而早期终止试验和基于结果选择性报告结局。观察性研究的主要局限性包括使用不合适的对照及未能充分调整预后的不平衡。偏倚风险可因不同结果而异(如全死因死亡率的失访远少于生命质量的失访),许多系统评价都容易忽略这一点。在决定是否因偏倚风险而降低质量等级时,不管是随机试验还是观察性研究,作者不应采用对各个研究取平均值的方法。相反,对任何单个结果,当同时存在高、低偏倚风险的研究时,则应考虑只纳入较低偏倚风险的研究。
引用
收藏
页码:456 / 463
页数:8
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