GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes

Gordon Guyatt, Andrew D. Oxman, Shahnaz Sultan, Jan Brozek, Paul Glasziou, Pablo Alonso-Coello, David Atkins, Regina Kunz, Victor Montori, Roman Jaeschke, David Rind, Philipp Dahm, Elie A. Akl, Joerg Meerpohl, Gunn Vist, Elise Berliner, Susan Norris, Yngve Falck-Ytter, Holger J. Schünemann

Research output: Contribution to journalArticle

347 Scopus citations

Abstract

GRADE requires guideline developers to make an overall rating of confidence in estimates of effect (quality of evidence - high, moderate, low, or very low) for each important or critical outcome. GRADE suggests, for each outcome, the initial separate consideration of five domains of reasons for rating down the confidence in effect estimates, thereby allowing systematic review authors and guideline developers to arrive at an outcome-specific rating of confidence. Although this rating system represents discrete steps on an ordinal scale, it is helpful to view confidence in estimates as a continuum, and the final rating of confidence may differ from that suggested by separate consideration of each domain. An overall rating of confidence in estimates of effect is only relevant in settings when recommendations are being made. In general, it is based on the critical outcome that provides the lowest confidence.

Original languageEnglish (US)
Pages (from-to)151-157
Number of pages7
JournalJournal of Clinical Epidemiology
Volume66
Issue number2
DOIs
StatePublished - Feb 1 2013

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Keywords

  • Confidence in estimates
  • GRADE
  • Guideline methodology
  • Quality of evidence
  • Systematic review methodology
  • Values and preferences

ASJC Scopus subject areas

  • Epidemiology

Cite this

Guyatt, G., Oxman, A. D., Sultan, S., Brozek, J., Glasziou, P., Alonso-Coello, P., Atkins, D., Kunz, R., Montori, V., Jaeschke, R., Rind, D., Dahm, P., Akl, E. A., Meerpohl, J., Vist, G., Berliner, E., Norris, S., Falck-Ytter, Y., & Schünemann, H. J. (2013). GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. Journal of Clinical Epidemiology, 66(2), 151-157. https://doi.org/10.1016/j.jclinepi.2012.01.006