Going from evidence to recommendations: Can GRADE get us there?

Journal of Evaluation in Clinical Practice
Mathew MercuriRoss E G Upshur

Abstract

The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a number of professional medical societies and organizations as a means for orienting the development of clinical guidelines. As a result, the method of GRADE has implications on how health care is delivered and patient outcomes. In this paper, we reveal several issues with the underlying logic of GRADE that warrant further discussion. First, the definitions of the "grades of evidence" provided by GRADE, while explicit, are functionally vague. Second, the "criteria for assigning grade of evidence" is seemingly arbitrary and arguably logically incoherent. Finally, the GRADE method is unclear on how to integrate evidence grades with other important factors, such as patient ...Continue Reading

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Citations

Jul 14, 2018·Journal of Evaluation in Clinical Practice·Mathew Mercuri, Brian S Baigrie
Jul 17, 2018·Journal of Evaluation in Clinical Practice·Mathew Mercuri, Amiram Gafni
Jul 18, 2018·Journal of Evaluation in Clinical Practice·Mathew Mercuri, Amiram Gafni
Aug 31, 2018·Journal of Evaluation in Clinical Practice·Michael LoughlinStephen Buetow
Feb 28, 2018·Journal of Evaluation in Clinical Practice·Benjamin DjulbegovicWilliam Dale
Feb 23, 2019·Journal of Evaluation in Clinical Practice·Sasha Lawson-Frost
May 3, 2019·Journal of Evaluation in Clinical Practice·Mathew Mercuri
Nov 27, 2020·Journal of Evaluation in Clinical Practice·Robert Mugerauer
Feb 12, 2021·Journal of Evaluation in Clinical Practice·Francesco De PretisWilliam Peden
Mar 5, 2021·Journal of Clinical Epidemiology·Benjamin DjulbegovicGordon Guyatt
Jun 18, 2021·PloS One·Francesco De Pretis, Jürgen Landes
May 23, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Christopher R CarpenterJeffrey A Kline
May 1, 2021·Ear and Hearing·Bénédicte VosElizabeth M Fitzpatrick

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