title: Grading quality of evidence and strength of recommendations.
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.
authors.forename: David
authors.initials: D
authors.lastname: Atkins
authors.forename: Dana
authors.initials: D
authors.lastname: Best
authors.forename: Peter A
authors.initials: PA
authors.lastname: Briss
authors.forename: Martin
authors.initials: M
authors.lastname: Eccles
authors.forename: Yngve
authors.initials: Y
authors.lastname: Falck-Ytter
authors.forename: Signe
authors.initials: S
authors.lastname: Flottorp
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: Robin T
authors.initials: RT
authors.lastname: Harbour
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Haugh
authors.forename: David
authors.initials: D
authors.lastname: Henry
authors.forename: Suzanne
authors.initials: S
authors.lastname: Hill
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Gillian
authors.initials: G
authors.lastname: Leng
authors.forename: Alessandro
authors.initials: A
authors.lastname: Liberati
authors.forename: Nicola
authors.initials: N
authors.lastname: Magrini
authors.forename: James
authors.initials: J
authors.lastname: Mason
authors.forename: Philippa
authors.initials: P
authors.lastname: Middleton
authors.forename: Jacek
authors.initials: J
authors.lastname: Mrukowicz
authors.forename: Dianne
authors.initials: D
authors.lastname: O'Connell
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Oxman
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: Tessa  Tan-Torres
authors.initials: T
authors.lastname: Edejer
authors.forename: Helena
authors.initials: H
authors.lastname: Varonen
authors.forename: Gunn E
authors.initials: GE
authors.lastname: Vist
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Stephanie
authors.initials: S
authors.lastname: Zaza
mesh_terms: D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care