Grading quality of evidence and strength of recommendations for diagnostic tests and strategies

doi:10.1136/bmj.39500.677199.AE

BMJ 2008;336:1106-1110 (17 May), doi:10.1136/bmj.39500.677199.AE

Analysis

Rating quality of evidence and strength of recommendations

Grading quality of evidence and strength of recommendations for diagnostic tests and strategies

Holger J Schünemann, professor¹^,2, Andrew D Oxman, researcher³, Jan Brozek, research fellow¹, Paul Glasziou, professor⁴, Roman Jaeschke, clinical professor⁵, Gunn E Vist, researcher³, John W Williams, Jr, professor⁶, Regina Kunz, associate professor⁷, Jonathan Craig, associate professor⁸, Victor M Montori, associate professor⁹, Patrick Bossuyt, professor¹⁰, Gordon H Guyatt, professor², for the GRADE Working Group

¹ Department of Epidemiology, Italian National Cancer Institute Regina Elena, 00144 Rome, Italy, ² CLARITY Research Group, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8N 3Z5, ³ Norwegian Knowledge Centre for the Health Services, PO Box 7004, 0130 Oslo, Norway, ⁴ Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford, Oxford OX3 7LF, ⁵ Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5, ⁶ Department of Medicine, Duke University and Durham VA Medical Center, Durham, NC 27705, USA, ⁷ Basel Institute of Clinical Epidemiology, University Hospital Basel, Hebelstrasse 10, 4031 Basel, Switzerland, ⁸ Screening and Test Evaluation Program, School of Public Health, University of Sydney, Department of Nephrology, Children’s Hospital at Westmead, Sydney, Australia, ⁹ Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA, ¹⁰ Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DE, Netherlands

Correspondence to: H J Schünemann schuneh@mcmaster.ca

Analysis, doi: 10.1136/bmj.39490.551019.BEAnalysis, doi: 10.1136/bmj.39489.470347.ADAnalysis, doi: 10.1136/bmj.39493.646875.AE

The GRADE system can be used to grade the quality of evidenceand strength of recommendations for diagnostic tests or strategies.This article explains how patient-important outcomes are takeninto account in this process

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

As for other interventions, the GRADE approachto grading the quality of evidence and strength of recommendationsfor diagnostic tests or strategies provides a comprehensiveand transparent approach for developing recommendations

Crosssectional or cohort studies can provide high quality evidenceof test accuracy

However, test accuracy is a surrogate forpatient-important outcomes, so such studies often provide lowquality evidence for recommendations about diagnostic tests,even when the studies do not have serious limitations

Inferringfrom data on accuracy that a diagnostic test or strategy improvespatient-important outcomes will require the availability ofeffective treatment, reduction of test related adverse effectsor anxiety, or improvement of patients’ wellbeing fromprognostic information

Judgments are thus needed to assessthe directness of test results in relation to consequences ofdiagnostic recommendations that are important to patients

In this fourth article of the five part series, we describehow guideline developers are . . . [Full text of this article]

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