title: GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes.
abstract: GRADE requires guideline developers to make an overall rating of confidence in estimates of effect (quality of evidence-high, moderate, low, or very low) for each important or critical outcome. GRADE suggests, for each outcome, the initial separate consideration of five domains of reasons for rating down the confidence in effect estimates, thereby allowing systematic review authors and guideline developers to arrive at an outcome-specific rating of confidence. Although this rating system represents discrete steps on an ordinal scale, it is helpful to view confidence in estimates as a continuum, and the final rating of confidence may differ from that suggested by separate consideration of each domain. An overall rating of confidence in estimates of effect is only relevant in settings when recommendations are being made. In general, it is based on the critical outcome that provides the lowest confidence.
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada. guyatt@mcmaster.ca
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Oxman
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Sultan
authors.forename: Jan
authors.initials: J
authors.lastname: Brozek
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.forename: David
authors.initials: D
authors.lastname: Atkins
authors.forename: Regina
authors.initials: R
authors.lastname: Kunz
authors.forename: Victor
authors.initials: V
authors.lastname: Montori
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: David
authors.initials: D
authors.lastname: Rind
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.forename: Joerg
authors.initials: J
authors.lastname: Meerpohl
authors.forename: Gunn
authors.initials: G
authors.lastname: Vist
authors.forename: Elise
authors.initials: E
authors.lastname: Berliner
authors.forename: Susan
authors.initials: S
authors.lastname: Norris
authors.forename: Yngve
authors.initials: Y
authors.lastname: Falck-Ytter
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
mesh_terms: D002983:Clinical Competence / Q000592:standards; D016001:Confidence Intervals; D004812:Epidemiologic Methods; D019317:Evidence-Based Medicine / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*