Title | GRADE guidelines: 9. Rating up the quality of evidence. |
Publication Type | Journal Article |
Year of Publication | 2011 |
Authors | 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 HM, Schünemann HJ |
Corporate Authors | GRADE Working Group |
Journal | Journal of clinical epidemiology |
Volume | 64 |
Issue | 12 |
Pagination | 1311-6 |
Date Published | 2011 Dec |
ISSN | 1878-5921 |
Keywords | Evidence-Based Medicine; Humans; Observer Variation; Practice Guidelines as Topic; Risk |
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. |
DOI | 10.1016/j.jclinepi.2011.06.004 |
Alternate Journal | J Clin Epidemiol |