GRADE guidelines: 9. Rating up the quality of evidence

Gordon H. Guyatt; Andrew D. Oxman; Shahnaz Sultan; Paul Glasziou; Elie A. Akl; Pablo Alonso-Coello; David Atkins; Regina Kunz; Jan Brozek; Victor Montori; Roman Jaeschke; David Rind; Philipp Dahm; Joerg Meerpohl; Gunn Vist; Elise Berliner; Susan Norris; Yngve Falck-Ytter; M. Hassan Murad; Holger J. Schünemann

doi:10.1016/j.jclinepi.2011.06.004

GRADE guidelines: 9. Rating up the quality of evidence

Gordon H. Guyatt^*, Andrew D. Oxman, Shahnaz Sultan, Paul Glasziou, Elie A. Akl, Pablo Alonso-Coello, David Atkins, Regina Kunz, Jan Brozek, Victor Montori, Roman Jaeschke, David Rind, Philipp Dahm, Joerg Meerpohl, Gunn Vist, Elise Berliner, Susan Norris, Yngve Falck-Ytter, M. Hassan Murad, Holger J. Schünemann

^*Corresponding author for this work

Institute for Evidence-Based Healthcare

Research output: Contribution to journal › Article › Research › peer-review

961 Citations (Scopus)

Abstract

The most common reason for rating up the quality of evidence is a large effect. GRADE suggests considering rating up quality of evidence one level when methodologically rigorous observational studies show at least a two-fold reduction or increase in risk, and rating up two levels for at least a five-fold reduction or increase in risk. Systematic review authors and guideline developers may also consider rating up quality of evidence when a dose-response gradient is present, and when all plausible confounders or biases would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect. Other considerations include the rapidity of the response, the underlying trajectory of the condition, and indirect evidence.

Original language	English
Pages (from-to)	1311-1316
Number of pages	6
Journal	Journal of Clinical Epidemiology
Volume	64
Issue number	12
DOIs	https://doi.org/10.1016/j.jclinepi.2011.06.004
Publication status	Published - Dec 2011

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Guyatt, G. H., Oxman, A. D., Sultan, S., Glasziou, P., Akl, E. A., Alonso-Coello, P., Atkins, D., Kunz, R., Brozek, J., Montori, V., Jaeschke, R., Rind, D., Dahm, P., Meerpohl, J., Vist, G., Berliner, E., Norris, S., Falck-Ytter, Y., Murad, M. H., & Schünemann, H. J. (2011). GRADE guidelines: 9. Rating up the quality of evidence. Journal of Clinical Epidemiology, 64(12), 1311-1316. https://doi.org/10.1016/j.jclinepi.2011.06.004

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abstract = "The most common reason for rating up the quality of evidence is a large effect. GRADE suggests considering rating up quality of evidence one level when methodologically rigorous observational studies show at least a two-fold reduction or increase in risk, and rating up two levels for at least a five-fold reduction or increase in risk. Systematic review authors and guideline developers may also consider rating up quality of evidence when a dose-response gradient is present, and when all plausible confounders or biases would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect. Other considerations include the rapidity of the response, the underlying trajectory of the condition, and indirect evidence.",

author = "Guyatt, {Gordon H.} and Oxman, {Andrew D.} and Shahnaz Sultan and Paul Glasziou and Akl, {Elie A.} and Pablo Alonso-Coello and David Atkins and Regina Kunz and Jan Brozek and Victor Montori and Roman Jaeschke and David Rind and Philipp Dahm and Joerg Meerpohl and Gunn Vist and Elise Berliner and Susan Norris and Yngve Falck-Ytter and Murad, {M. Hassan} and Sch{\"u}nemann, {Holger J.}",

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Guyatt, GH, Oxman, AD, Sultan, S, Glasziou, P, Akl, EA, Alonso-Coello, P, Atkins, D, Kunz, R, Brozek, J, Montori, V, Jaeschke, R, Rind, D, Dahm, P, Meerpohl, J, Vist, G, Berliner, E, Norris, S, Falck-Ytter, Y, Murad, MH & Schünemann, HJ 2011, 'GRADE guidelines: 9. Rating up the quality of evidence', Journal of Clinical Epidemiology, vol. 64, no. 12, pp. 1311-1316. https://doi.org/10.1016/j.jclinepi.2011.06.004

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AU - Akl, Elie A.

AU - Alonso-Coello, Pablo

AU - Atkins, David

AU - Kunz, Regina

AU - Brozek, Jan

AU - Montori, Victor

AU - Jaeschke, Roman

AU - Rind, David

AU - Dahm, Philipp

AU - Meerpohl, Joerg

AU - Vist, Gunn

AU - Berliner, Elise

AU - Norris, Susan

AU - Falck-Ytter, Yngve

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GRADE guidelines: 9. Rating up the quality of evidence

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