GRADE guidelines

9. Rating up the quality of evidence

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

Research output: Contribution to journalArticle

496 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1311-1316
Number of pages6
JournalJournal of Clinical Epidemiology
Volume64
Issue number12
DOIs
StatePublished - Dec 2011

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Guidelines
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Keywords

  • GRADE
  • Guidelines
  • Large effects
  • Level of evidence
  • Observational studies
  • Risk of bias

ASJC Scopus subject areas

  • Epidemiology

Cite this

Guyatt, G. H., Oxman, A. D., Sultan, S., Glasziou, P., Akl, E. A., Alonso-Coello, P., ... Schünemann, H. J. (2011). GRADE guidelines: 9. Rating up the quality of evidence. Journal of Clinical Epidemiology, 64(12), 1311-1316. https://doi.org/10.1016/j.jclinepi.2011.06.004

GRADE guidelines : 9. Rating up the quality of evidence. / Guyatt, Gordon H.; Oxman, Andrew D.; Sultan, Shahnaz; Glasziou, Paul; Akl, Elie A.; Alonso-Coello, Pablo; Atkins, David; Kunz, Regina; Brozek, Jan; Montori, Victor Manuel; Jaeschke, Roman; Rind, David; Dahm, Philipp; Meerpohl, Joerg; Vist, Gunn; Berliner, Elise; Norris, Susan; Falck-Ytter, Yngve; Murad, Mohammad H; Schünemann, Holger J.

In: Journal of Clinical Epidemiology, Vol. 64, No. 12, 12.2011, p. 1311-1316.

Research output: Contribution to journalArticle

Guyatt, GH, Oxman, AD, Sultan, S, Glasziou, P, Akl, EA, Alonso-Coello, P, Atkins, D, Kunz, R, Brozek, J, Montori, VM, Jaeschke, R, Rind, D, Dahm, P, Meerpohl, J, Vist, G, Berliner, E, Norris, S, Falck-Ytter, Y, Murad, MH & Schünemann, HJ 2011, 'GRADE guidelines: 9. Rating up the quality of evidence', Journal of Clinical Epidemiology, vol. 64, no. 12, pp. 1311-1316. https://doi.org/10.1016/j.jclinepi.2011.06.004
Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P et al. GRADE guidelines: 9. Rating up the quality of evidence. Journal of Clinical Epidemiology. 2011 Dec;64(12):1311-1316. https://doi.org/10.1016/j.jclinepi.2011.06.004
Guyatt, Gordon H. ; Oxman, Andrew D. ; Sultan, Shahnaz ; Glasziou, Paul ; Akl, Elie A. ; Alonso-Coello, Pablo ; Atkins, David ; Kunz, Regina ; Brozek, Jan ; Montori, Victor Manuel ; Jaeschke, Roman ; Rind, David ; Dahm, Philipp ; Meerpohl, Joerg ; Vist, Gunn ; Berliner, Elise ; Norris, Susan ; Falck-Ytter, Yngve ; Murad, Mohammad H ; Schünemann, Holger J. / GRADE guidelines : 9. Rating up the quality of evidence. In: Journal of Clinical Epidemiology. 2011 ; Vol. 64, No. 12. pp. 1311-1316.
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