TY - JOUR
T1 - GRADE approach to rate the certainty from a network meta-analysis
T2 - addressing incoherence
AU - GRADE Working Group
AU - Brignardello-Petersen, Romina
AU - Mustafa, Reem A.
AU - Siemieniuk, Reed A.C.
AU - Murad, M. Hassan
AU - Agoritsas, Thomas
AU - Izcovich, Ariel
AU - Schünemann, Holger J.
AU - Guyatt, Gordon H.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/4
Y1 - 2019/4
N2 - This article presents official guidance from the Grading of Recommendations Assessments, Development, and Evaluation (GRADE) working group on how to address incoherence when assessing the certainty in the evidence from network meta-analysis. Incoherence represents important differences between direct and indirect estimates that contribute to a network estimate. Bias due to limitations in study design or publication bias, indirectness, and intransitivity may be responsible for incoherence. Addressing incoherence requires a judgment regarding the importance of the impact on the network estimate. Reviewers need to be alert to the possibility of misguidedly arriving at excessively low ratings of certainty by rating down for both incoherence and other closely related GRADE domains. This article describes and illustrates each of these issues and provides explicit guidance on how to deal with them.
AB - This article presents official guidance from the Grading of Recommendations Assessments, Development, and Evaluation (GRADE) working group on how to address incoherence when assessing the certainty in the evidence from network meta-analysis. Incoherence represents important differences between direct and indirect estimates that contribute to a network estimate. Bias due to limitations in study design or publication bias, indirectness, and intransitivity may be responsible for incoherence. Addressing incoherence requires a judgment regarding the importance of the impact on the network estimate. Reviewers need to be alert to the possibility of misguidedly arriving at excessively low ratings of certainty by rating down for both incoherence and other closely related GRADE domains. This article describes and illustrates each of these issues and provides explicit guidance on how to deal with them.
KW - Certainty in the evidence
KW - GRADE
KW - Incoherence
KW - Inconsistency
KW - Network meta-analysis
KW - Quality of the evidence
KW - Systematic reviews
UR - http://www.scopus.com/inward/record.url?scp=85059584196&partnerID=8YFLogxK
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U2 - 10.1016/j.jclinepi.2018.11.025
DO - 10.1016/j.jclinepi.2018.11.025
M3 - Article
C2 - 30529648
AN - SCOPUS:85059584196
SN - 0895-4356
VL - 108
SP - 77
EP - 85
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -