TABLE D-1 Selected Approaches to Rating Strength of Evidence and Clinical Recommendations

System

Focus/Audience

Systems for Rating Evidence Quality

International Approaches

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group (2009)

Focus: Diagnosis and therapy

Grades of evidence Randomized trial: High Observational study: Low Any other evidence: Very low

Audience: Guideline developers

Decrease grade if limitations in study quality, important inconsistency of results, uncertainty about the directness of the evidence, imprecise or sparse data, and high risk of reporting bias.

A voluntary, international, collaboration

Increase grade if a very strong association, evidence of a dose–response gradient, presence of all plausible residual confounding would have reduced the observed effect.



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