GRADE guidelines: 9. Rating up the quality of evidence

被引：48

作者：

Guyatt, Gordon H. ^{[1
,2
]}

Oxman, Andrew D. ^{[3
]}

Sultan, Shahnaz ^{[4
]}

Glasziou, Paul ^{[5
]}

Akl, Elie A. ^{[6
]}

Alonso-Coello, Pablo ^{[7
,8
]}

Atkins, David ^{[9
]}

Kunz, Regina ^{[10
,11
]}

Brozek, Jan

Montori, Victor ^{[12
]}

Jaeschke, Roman ^{[2
]}

Rind, David ^{[13
,14
]}

Dahm, Philipp ^{[15
]}

Meerpohl, Joerg ^{[16
,17
]}

Vist, Gunn ^{[3
]}

Berliner, Elise ^{[18
]}

Norris, Susan ^{[19
]}

Falck-Ytter, Yngve ^{[20
]}

Murad, M. Hassan ^{[12
]}

Schuenemann, Holger J. ^{[2
]}

机构：

[1] McMaster Univ, Dept Clin Epidemiol & Biostat, CLARITY Res Grp, W Hamilton, ON L8N 3Z5, Canada

[2] McMaster Univ, Dept Med, W Hamilton, ON L8N 3Z5, Canada

[3] Norwegian Knowledge Ctr Hlth Serv, N-0130 Oslo, Norway

[4] Univ Florida, Dept Med, Div Gastroenterol Hepatol & Nutr, Gainesville, FL USA

[5] Bond Univ, Fac Hlth Sci, Ctr Res Evidence Based Practice, Gold Coast, Qld 4229, Australia

[6] SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA

[7] Univ Autonoma Barcelona, Iberoamer Cochrane Ctr, Serv Epidemiol Clin & Salud Publ, Barcelona 08041, Spain

[8] Univ Autonoma Barcelona, Hosp St Pau, CIBERESP, Barcelona 08041, Spain

[9] US EPA, Off Res & Dev, QUERI Program, Dept Vet Affairs, Washington, DC 20460 USA

[10] Univ Basel Hosp, Acad Swiss Insurance Med, CH-4031 Basel, Switzerland

[11] Univ Basel Hosp, Basel Inst Clin Epidemiol, CH-4031 Basel, Switzerland

[12] Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN USA

[13] Harvard Univ, Sch Med, Boston, MA USA

[14] UpToDate, Boston, MA USA

[15] Univ Florida, Dept Urol, Gainesville, FL USA

[16] Univ Med Ctr Freiburg, Inst Med Biometry & Med Informat, German Cochrane Ctr, D-79104 Freiburg, Germany

[17] Univ Med Ctr Freiburg, Dept Pediat & Adolescent Med, Div Pediat Hematol & Oncol, D-79106 Freiburg, Germany

[18] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Technol Assessment Program, Rockville, MD 20850 USA

[19] Oregon Hlth & Sci Univ, Dept Med Informat & Clin Epidemiol, Portland, OR 97239 USA

[20] Case Western Reserve Univ, Div Gastroenterol, Case & VA Med Ctr, Cleveland, OH 44106 USA

来源：

JOURNAL OF CLINICAL EPIDEMIOLOGY | 2011年 / 64卷 / 12期

基金：

英国医学研究理事会;

关键词：

GRADE; Guidelines; Level of evidence; Observational studies; Large effects; Risk of bias; VASOVAGAL PACEMAKER; PREVENTION; THERAPY; SYNCOPE; SEROCONVERSION; MULTICENTER; MORTALITY; DISEASE; VACCINE; RISK;

D O I：

10.1016/j.jclinepi.2011.06.004

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

100404 [儿少卫生与妇幼保健学];

摘要：

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. (C) 2011 Elsevier Inc. All rights reserved.

引用

页码：1311 / 1316

页数：6

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