An algorithm was developed to assign GRADE levels of evidence to comparisons within systematic reviews

Journal of Clinical Epidemiology
Alex PollockPhilip J Wiffen

Abstract

One recommended use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is supporting quality assessment of evidence of comparisons included within a Cochrane overview of reviews. Within our overview, reviewers found that current GRADE guidance was insufficient to make reliable and consistent judgments. To support our ratings, we developed an algorithm to grade quality of evidence using concrete rules. Using a pragmatic, exploratory approach, we explored the challenges of applying GRADE levels of evidence and developed an algorithm to applying GRADE levels of evidence in a consistent and transparent approach. Our methods involved application of algorithms and formulas to samples of reviews, expert panel discussion, and iterative refinement and revision. The developed algorithm incorporated four key criteria: number of participants, risk of bias of trials, heterogeneity, and methodological quality of the review. A formula for applying GRADE level of evidence from the number of downgrades assigned by the algorithm was agreed. Our algorithm which assigns GRADE levels of evidence using a set of concrete rules was successfully applied within our Cochrane overview. We propose that this methodolog...Continue Reading

References

Feb 17, 2007·BMC Medical Research Methodology·Beverley J SheaLex M Bouter
Apr 26, 2008·BMJ : British Medical Journal·Gordon H GuyattUNKNOWN GRADE Working Group
Feb 24, 2009·Journal of Clinical Epidemiology·Beverley J SheaMaarten Boers
Dec 28, 2010·Journal of Clinical Epidemiology·Gordon H GuyattAndre Knottnerus
Jan 5, 2011·Journal of Clinical Epidemiology·Gordon GuyattHolger J Schünemann
Feb 22, 2011·Journal of Clinical Epidemiology·Sharon E Straus, Sasha Shepperd
Apr 26, 2013·BMJ : British Medical Journal·Agnes DechartresPhilippe Ravaud
Aug 15, 2014·JAMA : the Journal of the American Medical Association·Agnes DechartresPhilippe Ravaud

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Citations

Jul 30, 2019·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Sama K CarleyJoel L Cohen
Jan 17, 2020·Journal of Clinical Nursing·Jorge Caro-BautistaJosé Miguel Morales-Asencio
Apr 8, 2020·Evidence-based Complementary and Alternative Medicine : ECAM·Jinke HuangHui Li
Jun 9, 2020·Evidence-based Complementary and Alternative Medicine : ECAM·Jinke HuangYong Huang
Jul 20, 2017·Systematic Reviews·Alex PollockLise Estcourt
Nov 14, 2018·Family Practice·Satoru KodamaHirohito Sone
Oct 27, 2020·Evidence-based Complementary and Alternative Medicine : ECAM·Jinke HuangYong Huang
May 1, 2021·Journal of Clinical Medicine·Alexandra VoinescuDanaë Stanton Fraser
Jun 3, 2021·International Journal of Environmental Research and Public Health·Yusuke HandaHiroshi Takasaki
Aug 21, 2021·Disability and Rehabilitation. Assistive Technology·Anne MacnamaraTobias Loetscher

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Software Mentioned

GRADE
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