GRADE guidelines: 3. Rating the quality of evidence

被引：5875

作者：

Balshem, Howard ^{[1
]}

Helfand, Mark ^{[2
]}

Schuenemann, Holger J. ^{[3
]}

Oxman, Andrew D. ^{[4
]}

Kunz, Regina ^{[5
]}

Brozek, Jan ^{[3
]}

Vist, Gunn E. ^{[4
]}

Falck-Ytter, Yngve ^{[6
]}

Meerpohl, Joerg ^{[7
,8
]}

Norris, Susan ^{[9
]}

Guyatt, Gordon H. ^{[3
]}

机构：

[1] Oregon Hlth & Sci Univ, BICC, Oregon Evidence Based Practice Ctr, Portland, OR 97239 USA

[2] Portland VA Med Ctr, Portland, OR USA

[3] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada

[4] Norwegian Knowledge Ctr Hlth Serv, N-0130 Oslo, Norway

[5] Univ Basel Hosp, Basel Inst Clin Epidemiol, CH-4031 Basel, Switzerland

[6] Case Western Reserve Univ, Div Gastroenterol, Case Med Ctr & VA, Cleveland, OH 44106 USA

[7] Univ Med Ctr Freiburg, German Cochrane Ctr, Inst Med Biometry & Med Informat, D-79104 Freiburg, Germany

[8] Univ Med Ctr Freiburg, Div Pediat Hematol & Oncol, Dept Pediat & Adolescent Med, D-79106 Freiburg, Germany

[9] Oregon Hlth & Sci Univ, Dept Med Informat & Clin Epidemiol, Portland, OR 97239 USA

来源：

JOURNAL OF CLINICAL EPIDEMIOLOGY | 2011年 / 64卷 / 04期

关键词：

Quality assessment; Body of evidence; Imprecision; Indirectness; Inconsistency; Publication bias; REYES-SYNDROME; 1ST EPISODE; ANTICOAGULATION;

D O I：

10.1016/j.jclinepi.2010.07.015

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

This article introduces the approach of GRADE to rating quality of evidence. GRADE specifies four categories high, moderate, low, and very low that are applied to a body of evidence, not to individual studies. In the context of a systematic review, quality reflects our confidence that the estimates of the effect are correct. In the context of recommendations, quality reflects our confidence that the effect estimates are adequate to support a particular recommendation. Randomized trials begin as high-quality evidence, observational studies as low quality. "Quality" as used in GRADE means more than risk of bias and so may also be compromised by imprecision, inconsistency, indirectness of study results, and publication bias. In addition, several factors can increase our confidence in an estimate of effect. GRADE provides a systematic approach for considering and reporting each of these factors. GRADE separates the process of assessing quality of evidence from the process of making recommendations. Judgments about the strength of a recommendation depend on more than just the quality of evidence. (C) 2011 Elsevier Inc. All rights reserved.

引用

页码：401 / 406

页数：6

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