GRADE guidelines: 3. Rating the quality of evidence.

TitleGRADE guidelines: 3. Rating the quality of evidence.
Publication TypeJournal Article
Year of Publication2011
AuthorsBalshem H, Helfand M, Sch├╝nemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH
JournalJournal of clinical epidemiology
Date Published2011 Apr
KeywordsEvidence-Based Medicine; Female; Guideline Adherence; Humans; Male; Practice Guidelines as Topic; Publication Bias; Quality Assurance, Health Care

This article introduces the approach of GRADE to rating 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. Randomized 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.

Alternate JournalJ Clin Epidemiol