Article review: Using GRADE to respond to health questions with different levels of urgency

Using GRADE to respond to health questions with different levels of urgency. Thayer KA, Schünemann HJ. Environ Int. 2016 Apr 25. pii: S0160-4120(16)30107-6

GRADE is a method of assessing the certainty in evidence (also known as quality of evidence or confidence in effect estimates) and the strength of recommendations in health care.  In the paper the authors acknowledge that trustworthy answers are required across different timeframes, sometimes in just hours.  They then go to show how GRADE provides useful guidance for assessing the evidence across various timeframes, this is summarised in Table 1. They highlight assessments for a variety of GRADE categories including risk of bias, imprecision, publication bias and magnitude of effects across four timeframes:

  • one or more hours
  • one to two weeks
  • one to three months
  • more than 3 months

In the summary they emphasise that even without a full systematic review, expressing the certainty in the evidence can provide useful guidance for users of the evidence.

GRADE is an important issue in relation to rapid reviews as it helps demonstrate that rapid methods does not mean lack of robustness.  It also highlights some key elements of evidence synthesis that users find useful – GRADE being one, but others such as reproducibility, transparency



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