GRADE guidelines: 22. The GRADE approach for tests and strategies-from test accuracy to patient-important outcomes and recommendations

被引：83

作者：

Schunemann, Holger J. ^{[1
,2
,3
]}

Mustafa, Reem A. ^{[1
,4
]}

Brozek, Jan ^{[1
,2
,3
]}

Santesso, Nancy ^{[1
,3
]}

Bossuyt, Patrick M. ^{[5
]}

Steingart, Karen R. ^{[6
]}

Leeflang, Mariska ^{[5
]}

Lange, Stefan ^{[7
]}

Trenti, Tommaso ^{[8
,9
]}

Langendam, Miranda ^{[5
]}

Scholten, Rob ^{[10
]}

Hooft, Lotty ^{[10
]}

Murad, Mohammad Hassan ^{[11
]}

Jaeschke, Roman ^{[1
,2
]}

Rutjes, Anne ^{[12
,13
]}

Singh, Jasvinder ^{[14
,15
]}

Helfand, Mark ^{[16
]}

Glasziou, Paul ^{[17
]}

Arevalo-Rodriguez, Ingrid ^{[18
,19
]}

Akl, Elie A. ^{[20
]}

Deeks, Jonathan J. ^{[21
]}

Guyatt, Gordon H. ^{[1
,2
]}

机构：

[1] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON L8S 4K1, Canada

[2] McMaster Univ, Dept Med, 1280 Main St West, Hamilton, ON L8S 4K1, Canada

[3] McMaster Univ, Michael DeGroote Cochrane Canada Ctr, McMaster GRADE Ctr, 1280 Main St West, Hamilton, ON L8S 4K1, Canada

[4] Univ Kansas, Med Ctr, Dept Med, Kansas City, KS 66103 USA

[5] Univ Amsterdam, Acad Med Ctr, Clin Epidemiol & Biostat & Bioinformat, Meibergdreef 9,POB 22700, NL-1100 DE Amsterdam, Netherlands

[6] Univ Liverpool Liverpool Sch Trop Med, Cochrane Infect Dis Grp, Liverpool L3 5QA, Merseyside, England

[7] Inst Qual & Efficiency Hlth Care IQWiG, Inst Qualitat & Wirtschaftlichkeit Gesundheitswes, Mediapk 8, D-50670 Cologne, Germany

[8] Azienda Osped Univ, Via Giardini 1355, I-41126 Modena, Italy

[9] Azienda USL Modena, Nuovo Osped S Agostino Estense, Via Giardini 1355, I-41126 Modena, Italy

[10] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Cochrane Netherlands, POB 85500, NL-3508 GA Utrecht, Netherlands

[11] Mayo Clin, Div Prevent Med, 200 1st ST SW, Rochester, MN 55902 USA

[12] Univ Bern, Inst Primary Hlth Care, Clin Trial Unit CTU Bern, Bern, Switzerland

[13] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland

[14] VA Med Ctr, Med Serv, Birmingham, AL USA

[15] Univ Alabama Birmingham, Dept Med, 510,20th St South,FOT805B, Birmingham, AL USA

[16] Oregon Hlth & Sci Univ, Portland VA Med Ctr, Oregon Evidence Based Practice Ctr, Portland, OR 97201 USA

[17] Bond Univ, Fac Hlth Sci & Med, CREBP, Gold Coast, Qld 4229, Australia

[18] Ramon y Cajal Hosp IRYCIS, Clin Biostat Unit, Madrid, Spain

[19] Fdn Univ Ciencias Salud, Hosp San Jose, Hosp Infanta San Jose, Div Res, Bogota, Colombia

[20] Amer Univ Beirut, Dept Internal Med, Beirut 11072020, Lebanon

[21] Univ Birmingham, Inst Appl Hlth Res, Test Evaluat Res Grp, Birmingham B15 2TT, W Midlands, England

来源：

JOURNAL OF CLINICAL EPIDEMIOLOGY | 2019年 / 111卷

关键词：

GRADE; Guidelines; Recommendations; Systematic reviews; Diagnosis; Tests; Frameworks; HEALTH-ORGANIZATION GUIDELINES; MILK ALLERGY DRACMA; SYSTEMATIC REVIEWS; DIAGNOSIS; METAANALYSES; CRYOTHERAPY; RATIONALE;

D O I：

10.1016/j.jclinepi.2019.02.003

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can-and often does-lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use. (C) 2019 Published by Elsevier Inc.

引用

页码：69 / 82

页数：14

共 3 条

[1] From evidence to recommendations: developing health care guidelines following the GRADE approach
Lesniak, Wiktoria
Bala, Malgorzata M.
Jaeschke, Roman
Brozek, Jan L.
POLSKIE ARCHIWUM MEDYCYNY WEWNETRZNEJ-POLISH ARCHIVES OF INTERNAL MEDICINE, 2015, 125 : 26 - 41
[2] Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies
Brozek, J. L.
Akl, E. A.
Jaeschke, R.
Lang, D. M.
Bossuyt, P.
Glasziou, P.
Helfand, M.
Ueffing, E.
Alonso-Coello, P.
Meerpohl, J.
Phillips, B.
Horvath, A. R.
Bousquet, J.
Guyatt, G. H.
Schuenemann, H. J.
ALLERGY, 2009, 64 (08) : 1109 - 1116
[3] Guidelines for the Prophylaxis and Treatment of Peritoneal Metastases From Colorectal Cancer: A GRADE-Approach for Evidence Evaluation and Recommendations
Goere, Diane
Kusamura, Shigeki
Lurvink, Robin J.
Cinquini, Michela
Piso, Pompiliu
Levine, Edward
Hubner, Martin
Guiral, Delia Cortes
Brandl, Andreas
Spinelli, Antonino
De Hingh, Ignace H. J. T.
Deraco, Marcello
JOURNAL OF SURGICAL ONCOLOGY, 2024,

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