GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings

Linan Zeng; Romina Brignardello-Petersen; Monica Hultcrantz; Reed A C Siemieniuk; Nancy Santesso; Gregory Traversy; Ariel Izcovich; Behnam Sadeghirad; Paul E Alexander; Tahira Devji; Bram Rochwerg; Mohammad H Murad; Rebecca Morgan; Robin Christensen; Holger J Schünemann; Gordon H Guyatt

doi:10.1016/j.jclinepi.2021.03.026

GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings

J Clin Epidemiol. 2021 Sep:137:163-175. doi: 10.1016/j.jclinepi.2021.03.026. Epub 2021 Apr 20.

Authors

Linan Zeng¹, Romina Brignardello-Petersen², Monica Hultcrantz³, Reed A C Siemieniuk², Nancy Santesso², Gregory Traversy⁴, Ariel Izcovich⁵, Behnam Sadeghirad⁶, Paul E Alexander², Tahira Devji², Bram Rochwerg⁷, Mohammad H Murad⁸, Rebecca Morgan², Robin Christensen⁹, Holger J Schünemann⁷, Gordon H Guyatt⁷

Affiliations

¹ Pharmacy Department/ Evidence-based Pharmacy Centre, West China Second University Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China, 610041; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8. Electronic address: zengl15@mcmaster.ca.
² Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8.
³ Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, SE-102 33, Stockholm, Sweden.
⁴ Public Health Agency of Canada. 785 Carling Avenue, Ottawa, Ontario, Canada, K1A 0K9.
⁵ Internal Medicine Service, German Hospital, Pueyrred_on 1640, Buenos Aires C1118AAT, Argentina.
⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8; Department of Anesthesia, McMaster University, 1200 Main Street West Hamilton, Ontario, Canada, L8N 3Z5.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4K1.
⁸ Mayo Clinic Evidence-based Practice Center, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA 55905.
⁹ Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, DK-2000 Copenhagen F, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.

PMID: 33857619
DOI: 10.1016/j.jclinepi.2021.03.026

Abstract

Objective: To provide practical principles and examples to help GRADE users make optimal choices regarding their ratings of certainty of evidence using a minimally or partially contextualized approach.

Study design and setting: Based on the GRADE clarification of certainty of evidence in 2017, a project group within the GRADE Working Group conducted iterative discussions and presentations at GRADE Working Group meetings to refine this construct and produce practical guidance.

Results: Systematic review and health technology assessment authors need to clarify what it is in which they are rating their certainty of evidence (i.e., the target of their certainty rating). The decision depends on the degree of contextualization (partially or minimally contextualized), thresholds (null, small, moderate or large effect threshold), and where the point estimate lies in relation to the chosen threshold(s). When the 95% confidence interval crosses multiple possible thresholds (i.e., including both large benefit and large harm), it is not worthwhile for authors to determine the target of certainty rating.

Conclusion: GRADE provides practical principles to help systematic review and health technology assessment authors specify the target of their certainty of evidence rating.

Keywords: Evidence-based medicine; GRADE; Health technology assessment; Systematic review; Target of certainty of evidence rating; Thresholds.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

GRADE Approach*
Humans
Practice Guidelines as Topic
Systematic Reviews as Topic

Grants and funding

CIHR/Canada