Cited by 577Clinical practice guidelines implementationHealth Sciences Research and EducationMeta-analysis and systematic reviews

An official ATS statement: Grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations.

Schünemann, Holger J., Jaeschke, Roman, Cook, Deborah J., Bria, William F., El-Solh, Ali A., Ernst, Armin, Fahy, Bonnie F., Gould, Michael K. +9 more·2006·American Journal of Respiratory and Critical Care Medicine

Abstract

Grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical practice guidelines. Professional societies and other organizations, including the American Thoracic Society (ATS), should reach consensus about whether they will use one common grading system and which of the numerous grading systems they would apply across all guidelines. The profusion of guideline grading systems confuses consumers of guidelines, and undermines the value of the grading exercise in conveying a transparent message. In response to this dilemma, the international GRADE working group has developed an approach that is useful for many guideline contexts, and that several national and international organizations have adopted. The GRADE system classifies recommendations as strong or weak, according to the balance of the benefits and downsides (harms, burden, and cost) after considering the quality of evidence. The quality of evidence reflects the confidence in estimates of the true effects of an intervention, and the system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, the consistency and precision of the results, and the directness of the evidence. On recommendation of the ATS Documents Development and Implementation Committee, the ATS adopted the GRADE approach for its guidelines in line with many other organizations that have recently chosen the GRADE approach. This article informs ATS guideline developers, investigators, and those interpreting future ATS guidelines that follow the GRADE approach about the methodology and applicability of ATS guidelines and recommendations.

Integrity signals

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Crossref · 10.1164/rccm.200602-197st

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35 of 35 references verified0 citation errors · 0 not checkable

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  • The quality of evidence may differ across outcomes within a study, such as between a primary efficacy outcome and the assessment of serious harms.

    “The quality of evidence may differ across outcomes, even within a study, such as between a primary efficacy outcome, which is likely to be very carefully and systematically measured, and the assessment of serious harms [39], which may rely on spontaneous reports by investigators.”

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Authors
Schünemann, H. J., Jaeschke, R., Cook, D. J., Bria, W. F., El-Solh, A. A., Ernst, A., Fahy, B. F., Gould, M. K., Horan, K. L., Krishnan, J. A., Manthous, C. A., Maurer, J. R., McNicholas, W. T., Oxman, A. D., Rubenfeld, G., Turino, G. M., & Guyatt, G.
Affiliations
American Thoracic Society (US)
Venue
American Journal of Respiratory and Critical Care Medicine
Published
2006-09-01
Volume
174
Issue
5
Pages
605-614
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
OpenAlex
W2144086043
Cited by
577
References
35
Citations by year
2026: 1 · 2025: 12 · 2024: 12 · 2023: 18 · 2022: 15 · 2021: 12 · 2020: 21 · 2019: 22 · 2018: 30 · 2017: 23 · 2016: 37 · 2015: 36 · 2014: 38 · 2013: 37 · 2012: 48
FWCI
39.95
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
World Health Organization
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Keywords
GRADE, quality of evidence, strength of recommendation, guideline development, evidence-based medicine
MeSH terms
Health Policy, Humans, Research Design, Practice Guidelines as Topic, Risk Assessment, Evidence-Based Medicine, Guideline Adherence

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