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      GRADE guidelines: 3. Rating the quality of evidence.

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          Abstract

          This article introduces the approach of GRADE to rating quality of evidence. GRADE specifies four categories-high, moderate, low, and very low-that are applied to a body of evidence, not to individual studies. In the context of a systematic review, quality reflects our confidence that the estimates of the effect are correct. In the context of recommendations, quality reflects our confidence that the effect estimates are adequate to support a particular recommendation. Randomized trials begin as high-quality evidence, observational studies as low quality. "Quality" as used in GRADE means more than risk of bias and so may also be compromised by imprecision, inconsistency, indirectness of study results, and publication bias. In addition, several factors can increase our confidence in an estimate of effect. GRADE provides a systematic approach for considering and reporting each of these factors. GRADE separates the process of assessing quality of evidence from the process of making recommendations. Judgments about the strength of a recommendation depend on more than just the quality of evidence.

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          Author and article information

          Journal
          J Clin Epidemiol
          Journal of clinical epidemiology
          Elsevier BV
          1878-5921
          0895-4356
          Apr 2011
          : 64
          : 4
          Affiliations
          [1 ] Oregon Evidence-based Practice Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA. balshemh@ohsu.edu
          Article
          S0895-4356(10)00332-X
          10.1016/j.jclinepi.2010.07.015
          21208779
          96c525bc-01ec-43e8-a801-18fe905a2784
          Copyright © 2011 Elsevier Inc. All rights reserved.
          History

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