GRADE指南:Ⅵ.证据质量评价——不精确性(随机误差)

被引：90

作者：

Gordon Guyatt

Andrew D.Oxman

Regina Kunz

Jan Brozek

Pablo Alonso-Coello

David Rind

PJ Devereaux

Victor M.Montori

Bo Freyschuss

Gunn Vist

Roman Jaeschke

John W.Williams Jr.

Mohammad Hassan Murad

David Sinclairk

Yngve Falck-Ytter

Joerg Meerpohl

Craig Whittington

Kristian orlund

Je Andrews

Holger J.Schünemann

代表GRADE工作组

李幼平

王莉

陈尹

高霑

机构：

来源：

中国循证医学杂志 | 2011年 / 12期

关键词：

GRADE; 证据质量; 估计值把握度; 不精确性; 最优样本信息量; 可信区间;

D O I：

暂无

中图分类号：

R-03 [];

学科分类号：

摘要：

GRADE建议通过检查95%可信区间(CI)为决定不精确性的最佳方法。在指南实际运用中,如果CI的上、下限值代表了真实效应,而临床实际情况与之不符时,必须降低证据质量级别(即对效应估计值的把握度)。除外当效应值很大且可信区间提示效应稳健,而总样本量不大且事件数很少的情况,其他应考虑因不精确性而降低证据质量级别。作此决定时,可计算有足够检验效能的单个试验所需的病例数(定义为"最优信息样本量",即optimal information size,OIS)。对连续型变量,我们建议用类似方法,首先考虑可信区间上、下限值,再计算OIS。系统评价(SR)所需方法略有不同。如果95%CI不包括相对危险度(RR)为1,且总事件发生数或病例数超过OIS标准,则精确性良好。如果95%CI包括了明显获益或危害(我们建议以RR值<0.75或>1.25作粗标准),即使达到OIS要求,因不精确性而降低证据质量级别较恰当。

引用

页码：1435 / 1443

页数：9

共 11 条

[1]

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis[J] The Lancet 2008,

[2]

Endarterectomy vs stenting for carotid artery stenosis: A systematic review and meta-analysis[J] M. Hassan Murad;David N. Flynn;Mohamed B. Elamin;Gordon H. Guyatt;Robert W. Hobson;Patricia J. Erwin;Victor M. Montori Journal of Vascular Surgery 2008,

[3]

Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial[J] Devereaux P J;Yang Homer;Yusuf Salim;Guyatt Gordon;Leslie Kate;Villar Juan Carlos;Xavier Denis;Chrolavicius Susan;Greenspan Launi;Pogue Janice;Pais Prem;Liu Lisheng;Xu Shouchun;Málaga German;Avezum Alvaro;Chan Matthew;Montori Victor M;Jacka Mike;Choi Peter The Lancet 2008,

[4]

Contemporary Management of Acute Exacerbations of COPD[J] Bradley S. Quon;Wen Qi Gan;Don D. Sin Chest 2008,

[5]

How Strong Is The Evidence For The Use Of Perioperative β Blockers In Non-Cardiac Surgery? Systematic Review And Meta-Analysis Of Randomised Controlled Trials[J] P. J. Devereaux;W. Scott Beattie;Peter T-L Choi;Neal H. Badner;Gordon H. Guyatt;Juan C. Villar;Claudio S. Cinà;Kate Leslie;Michael J. Jacka;Victor M. Montori;Mohit Bhandari;Alvaro Avezum;Alexandre B. Cavalcanti;Julian W. Giles;Thomas Schricker;Homer Yang;Carl-Johan Jakobsen;Salim Yusuf BMJ: British Medical Journal 2005,

[6]

Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers for Prevention of Type 2 Diabetes[J] Hussam Abuissa;Philip G. Jones;Steven P. Marso;James H. O’Keefe Journal of the American College of Cardiology 2005,

[7]

Effect sizes in cumulative meta-analyses of mental health randomized trials evolved over time[J] Thomas A. Trikalinos;Rachel Churchill;Marica Ferri;Stefan Leucht;Arja Tuunainen;Kristian Wahlbeck;John P.A. Ioannidis Journal of Clinical Epidemiology 2004,

[8]

Human Albumin Administration in Critically Ill Patients: Systematic Review of Randomised Controlled Trials[J] Cochrane Injuries Group Albumin Reviewers BMJ: British Medical Journal 1998,

[9]

Cumulating evidence from randomized trials: Utilizing sequential monitoring boundaries for cumulative meta-analysis[J] Janice M. Pogue;Salim Yusuf Controlled Clinical Trials 1997,

[10]

ISIS-4: A randomised factorial trial assessing early oral captopril; oral mononitrate; and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction[J] The Lancet 1995,

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