title: [GRADE guidelines: 3. Rating the quality of evidence (confidence in the estimates of effect)].
abstract: This article introduces the GRADE approach to rating the 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. Randomised 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.
authors.affiliation: Deutsches Cochrane Zentrum, Institut für Medizinische Biometrie und Medizinische Informatik, Universitätsklinikum FreiburgundKlinik IV. meerpohl@cochrane.de
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
authors.forename: Gero
authors.initials: G
authors.lastname: Langer
authors.forename: Matthias
authors.initials: M
authors.lastname: Perleth
authors.forename: Gerald
authors.initials: G
authors.lastname: Gartlehner
authors.forename: Angela
authors.initials: A
authors.lastname: Kaminski-Hartenthaler
authors.forename: Holger
authors.initials: H
authors.lastname: Schünemann
mesh_terms: D002983:Clinical Competence / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards*; D005858:Germany; D019983:Guideline Adherence / Q000592:standards*; D015276:Health Care Rationing / Q000592:standards*; D006801:Humans; D009313:National Health Programs / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D016896:Treatment Outcome