Cited by 762Meta-analysis and systematic reviewsClinical practice guidelines implementationDelphi Technique in Research

GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes

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Guyatt, Gordon, Oxman, Andrew D., Sultan, Shahnaz, Brozek, Jan, Glasziou, Paul, Alonso-Coello, Pablo, Atkins, David, Kunz, Regina +11 more·2013·Journal of Clinical Epidemiology

Abstract

GRADE requires guideline developers to make an overall rating of confidence in estimates of effect (quality of evidence-high, moderate, low, or very low) for each important or critical outcome. GRADE suggests, for each outcome, the initial separate consideration of five domains of reasons for rating down the confidence in effect estimates, thereby allowing systematic review authors and guideline developers to arrive at an outcome-specific rating of confidence. Although this rating system represents discrete steps on an ordinal scale, it is helpful to view confidence in estimates as a continuum, and the final rating of confidence may differ from that suggested by separate consideration of each domain. An overall rating of confidence in estimates of effect is only relevant in settings when recommendations are being made. In general, it is based on the critical outcome that provides the lowest confidence.

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Authors
Guyatt, G., Oxman, A. D., Sultan, S., Brozek, J., Glasziou, P., Alonso-Coello, P., Atkins, D., Kunz, R., Montori, V., Jaeschke, R., Rind, D., Dahm, P., Akl, E. A., Meerpohl, J., Vist, G., Berliner, E., Norris, S., Falck-Ytter, Y., & Schünemann, H. J.
Affiliations
  • McMaster University (CA)
  • Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
  • University of Florida Health (US)
  • Iberoamerican Cochrane Centre (ES)
  • University Hospital of Basel (CH)
  • Mayo Clinic (US)
  • Harvard University (US)
  • University of Florida (US)
  • University at Buffalo, State University of New York (US)
  • University Medical Center Freiburg (DE)
  • Oregon Health & Science University (US)
  • Case Western Reserve University (US)
Corresponding author
Guyatt, Gordon
Venue
Journal of Clinical Epidemiology
Publisher
Elsevier BV
Published
2013-02
Volume
66
Issue
2
Pages
151-157
ISSN
0895-4356 (ISSN-L)
OpenAlex
W2107021177
Cited by
762
References
13
Citations by year
2026: 46 · 2025: 52 · 2024: 56 · 2023: 58 · 2022: 54 · 2021: 64 · 2020: 54 · 2019: 64 · 2018: 55 · 2017: 80 · 2016: 54 · 2015: 51 · 2014: 39 · 2013: 25 · 2012: 7
FWCI
44.39
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • e-publications@bond (Bond University) (submittedVersion)
  • edoc (University of Basel) (submittedVersion)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords
GRADE, quality of evidence, critical outcomes, evidence-based guideline development, systematic reviews
MeSH terms
Clinical Competence, Epidemiologic Methods, Humans, Confidence Intervals, Outcome Assessment, Health Care, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence

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