GRADE: assessing the quality of evidence for diagnostic recommendations
Authors: Holger J. Schünemann
Journal: Annals of Internal Medicine (2008)

ACP Journal ClubDecember 16, 2008GRADE: assessing the quality of evidence for diagnostic recommendationsHolger J. Schünemann, MD, PhD, Andrew D. Oxman, MD, MSc, Jan Brozek, MD, PhD, Paul Glasziou, MD, PhD, Patrick Bossuyt, PhD, Stephanie Chang, MD, MPH, Paola Muti, MD, MSc, Roman Jaeschke, MD, MSc, Gordon H. Guyatt, MD, MScHolger J. Schünemann, MD, PhDMcMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.), Andrew D. Oxman, MD, MScNorwegian Knowledge Centre for the Health Services, Oslo, Norway (A.D.O.), Jan Brozek, MD, PhDItalian National Cancer Institute Regina Elena, Rome, Italy (J.B., P.M.)Italian National Cancer Institute Regina Elena, Rome, Italy (J.B., P.M.), Paul Glasziou, MD, PhDUniversity of Oxford, Oxford, United Kingdom (P.G.), Patrick Bossuyt, PhDUniversity of Amsterdam,, Amsterdam, Netherlands (P.B.), Stephanie Chang, MD, MPHAgency for Healthcare Research and Quality, Rockville, Maryland, USA (S.C.), Paola Muti, MD, MScItalian National Cancer Institute Regina Elena, Rome, Italy (J.B., P.M.)Italian National Cancer Institute Regina Elena, Rome, Italy (J.B., P.M.), Roman Jaeschke, MD, MScMcMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.), Gordon H. Guyatt, MD, MScMcMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-12-200812160-02002 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Making a diagnosis is the bread and butter of clinical practice, but in light of the number of tests now available to clinician, diagnosing illness has become a complicated process. Guidelines for making an evidence-based diagnosis abound, but those making recommendations about diagnostic tests or test strategies must realize that clinicians require support to make diagnostic decisions that they can easily implement in daily practice. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group has developed a rigorous, transparent, and increasingly adopted approach for grading the quality of research evidence and strength of recommendations to guide clinical practice. ...References1 Schünemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336:1106-10. [PMID: 18483053] Google Scholar2 Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157-62. [PMID: 11463691] Google Scholar3 Khromova V, Gray TA. Learning needs in clinical biochemistry for doctors in foundation years. Ann Clin Biochem. 2008;45:33-8. [PMID: 18275671] Google Scholar4 Hickner J, Graham DG, Elder NC, et al. 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Empirical evidence of design-related bias in studies of diagnostic tests. JAMA. 1999;282:1061-6. [PMID: 10493205] Google Scholar10 Worster A, Preyra I, Weaver B, Haines T. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis. Ann Emerg Med. 2002;40:280-6. [PMID: 12192351] Google Scholar11 Worster A, Haines T. Does replacing intravenous pyelography with noncontrast helical computed tomography benefit patients with suspected acute urolithiasis? Can Assoc Radiol J. 2002;53:144-8. [PMID: 12101535] Google Scholar Author, Article, and Disclosure InformationAuthors: Holger J. Schünemann, MD, PhD; Andrew D. Oxman, MD, MSc; Jan Brozek, MD, PhD; Paul Glasziou, MD, PhD; Patrick Bossuyt, PhD; Stephanie Chang, MD, MPH; Paola Muti, MD, MSc; Roman Jaeschke, MD, MSc; Gordon H. Guyatt, MD, MScAffiliations: McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)Norwegian Knowledge Centre for the Health Services, Oslo, Norway (A.D.O.)Italian National Cancer Institute Regina Elena, Rome, Italy (J.B., P.M.)University of Oxford, Oxford, United Kingdom (P.G.)University of Amsterdam,, Amsterdam, Netherlands (P.B.)Agency for Healthcare Research and Quality, Rockville, Maryland, USA (S.C.)Italian National Cancer Institute Regina Elena, Rome, Italy (J.B., P.M.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.)McMaster University, Hamilton, Ontario, Canada (H.J.S., R.J., G.H.G.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics December 16, 2008Volume 149, Issue 12Page: JC6-2KeywordsBiochemistryBreadComputed axial tomographyDatabasesFallsForecastingGenetic testingKidney stonesObservational studiesPyelographyResearch quality assessmentScientistsSigns and symptomsSpecificitySystematic reviewsTreatment guidelinesTriage ePublished: 10 March 2020 Issue Published: December 16, 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...