Grading quality of evidence and strength of recommendations

David C. Atkins , Dana Best , Peter A. Briss , David C. Atkins , Dana Best , Peter A. Briss , Martin Eccles , Yngve Falck–Ytter , Signe Flottorp , Gordon Guyatt , Robin Harbour , Margaret Haugh , David Henry , Suzanne Hill , Roman Jaeschke , Gillian Leng , Alessandro Liberati , Nicola Magrini , James Mason , Philippa Middleton , Jacek Mrukowicz , Dianne O’Connell , Andrew D Oxman , Bob Phillips , Holger J. Schünemann , Tessa Tan-Torres Edejer , Helena Varonen , Gunn Elisabeth Vist , John W Williams , Stephanie Zaza
2004 BMJ 8,128 citations

Abstract

Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.

Keywords

Grading (engineering)Quality of evidenceRisk analysis (engineering)Computer scienceCertaintyGuidelinePsychological interventionQuality (philosophy)Process managementPsychologyMeta-analysisMedicineBusinessEngineering

Related Publications

Publication Info

Year
2004
Type
article
Volume
328
Issue
7454
Pages
1490-1490
Citations
8128
Access
Closed

External Links

View on DOI.org

Social Impact

Altmetric
PlumX Metrics

Social media, news, blog, policy document mentions

Citation Metrics

8128
OpenAlex

Cite This

David C. Atkins, Dana Best, Peter A. Briss et al. (2004). Grading quality of evidence and strength of recommendations. BMJ , 328 (7454) , 1490-1490. https://doi.org/10.1136/bmj.328.7454.1490

Identifiers

DOI
10.1136/bmj.328.7454.1490