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