GRADE guidelines: 9. Rating up the quality of evidence.

TitleGRADE guidelines: 9. Rating up the quality of evidence.
Publication TypeJournal Article
Year of Publication2011
AuthorsGuyatt 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, Sch├╝nemann HJ
Corporate AuthorsGRADE Working Group
JournalJournal of clinical epidemiology
Date Published2011 Dec
KeywordsEvidence-Based Medicine; Humans; Observer Variation; Practice Guidelines as Topic; Risk

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.

Alternate JournalJ Clin Epidemiol