A new system for grading recommendations in evidence based guidelines

doi:10.1136/bmj.323.7308.334

BMJ 2001;323:334-336 ( 11 August )

Education and debate

A new system for grading recommendations in evidence based guidelines

Robin Harbour, information manager, Juliet Miller, director, for the Scottish Intercollegiate Guidelines Network Grading Review Group.

Scottish Intercollegiate Guidelines Network, Royal College of Physicians of Edinburgh, Edinburgh EH2 1JQ

Correspondence to: R Harbour r.harbour@rcpe.ac.uk

The first 150 words of the full text of this article appear below.

The Scottish Intercollegiate Guidelines Network (SIGN) develops evidence based clinical guidelines for the NHS in Scotland.The key elements of the methodology are (a) that guidelines aredeveloped by multidisciplinary groups; (b) they are based on asystematic review of the scientific evidence; and (c) recommendationsare explicitly linked to the supporting evidence and graded accordingto the strength of thatevidence.

Until recently, the system for grading guideline recommendations was based on the work of the US Agency for Healthcare Researchand Quality (formerly the Agency for Health Care Policy and Research). ¹ ² However, experience over more than five years of guideline developmentled to a growing awareness of this system's weaknesses. Firstly,the grading system was designed largely for application to questionsof effectiveness, where randomised controlled trials are acceptedas the most robust study design with the least risk of bias inthe results. However, in many areas . . . [Full text of this article]

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