Intended for healthcare professionals

Research Methods & Reporting

GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2089 (Published 30 June 2016) Cite this as: BMJ 2016;353:i2089

Re: GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines

I very much enjoyed reading Paper 1 in this series of two articles. As I am in the process of perusing this paper 2, I have one minor comment to share:

In Figure 1, for the outcome of death, the 95% CI is 17 less to 1 more per 1000 patients. Because it is not possible for me to know which value within the 95% confidence interval denotes the population parameter, I am not sure I can conclude, unlike the plain language summary, that “Dabigatran probably reduces the risk of dying” with moderate confidence. If I can, then maybe I can also conclude with equal certainty that Dabigatran probably does not reduce the risk of dying. And if the language of the outcome specific plain language summary has any (intentional or unintentional) role to play in going from evidence to decisions, then over-focusing on the point estimate could be potentially problematic.

Competing interests: No competing interests

27 July 2016
Mohammed T. Ansari
Adjunct Professor
University of Ottawa
Ottawa, ON, CANADA