Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions
Abstract
The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system’s conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three‐part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel’s confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence.
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The guideline was developed and reported in accordance with GRADE methodology and AGREE II standards.
“Development and reporting conformed to GRADE guidelines and AGREE II standards.”
Screening using the STOP-BANG criteria seemed to be predictive of postoperative complications in several observational studies.
“Nevertheless, screening using the STOP-BANG criteria seemed to be predictive of postoperative complications in several observational studies [3, 4, 8, 9, 47, 48, 52, 53].”
Analysis of long-term (≥5 years) and very long-term (≥10 years) evidence suggested an excess weight loss between 42% and 55% for sleeve gastrectomy.
“Analysis of long-term (≥ 5 years) and very long-term (≥ 10 years) evidence suggested an EWL between 42 and 55% with a mean weight regain between 9 and 31% for sleeve gastrectomy [9, 10, 92, 93].”
Analysis of long-term (≥5 years) and very long-term (≥10 years) evidence suggested a mean weight regain between 9% and 31% for sleeve gastrectomy.
“Analysis of long-term (≥ 5 years) and very long-term (≥ 10 years) evidence suggested an EWL between 42 and 55% with a mean weight regain between 9 and 31% for sleeve gastrectomy [9, 10, 92, 93].”
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- Authors
- Brożek, J. L., Akl, E. A., Alonso‐Coello, P., Lang, D., Jaeschke, R., Williams, J. W., Phillips, B., Lelgemann, M., Lethaby, A., Bousquet, J., Guyatt, G. H., Schünemann, H. J., & for the GRADE Working Group
- Affiliations
- Jagiellonian University (PL)
- University at Buffalo, State University of New York (US)
- Hospital de Sant Pau (ES)
- Cleveland Clinic (US)
- McMaster University (CA)
- Duke University (US)
- University of York (GB)
- University of Bremen (DE)
- University of Auckland (NZ)
- Inserm (FR)
- Instituto Nazionale Tumori Regina Elena (IT)
- Corresponding author
- Schünemann, H. J.
- ORCID
- Venue
- Allergy
- Publisher
- Wiley
- Published
- 2009-04
- Volume
- 64
- Issue
- 5
- Pages
- 669-677
- ISSN
- 0105-4538 (ISSN-L)
- 1398-9995
- OpenAlex
- W1968350578
- Cited by
- 894
- References
- 65
- Citations by year
- 2026: 57 · 2025: 78 · 2024: 106 · 2023: 87 · 2022: 80 · 2021: 67 · 2020: 50 · 2019: 41 · 2018: 31 · 2017: 43 · 2016: 33 · 2015: 49 · 2014: 41 · 2013: 39 · 2012: 30
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Allergy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- GRADE framework, quality of evidence, strength of recommendation, asthma, evidence-based medicine, research methodology
- MeSH terms
- Humans, Quality Assurance, Health Care, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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