目标:建议评估的分级,目前,对不精确的确定性域进行评级的开发和评估(GRADE)指南尚未完全用于将评级降低两个级别,并且考虑了这些风险中的不同基线风险或不确定性。此外,在某些情况下,由于不精确而将证据的确定性降低三个级别比降低两个级别更合适。在这篇文章中,我们将不精确的评级概念化和操作化,使用上下文化的等级方法和做出决策的不精确的两个和三个级别。
方法:通过在线会议中的迭代讨论和改进以及通过电子邮件通信,我们制定了指南草案,根据例子将证据的确定性降低了三个级别。主要作者根据这些会议期间收到的反馈和评论修改了该方法,并制定了如何应用该方法的GRADE指南。我们向2021年10月GRADE工作组会议的所有与会者(约80人)提供了结果摘要,该方法已正式批准。
结果:本指南提供了GRADE的新颖方法,用于考虑将不精确评分降低一个,基于严重的两个和三个级别,非常严重和极其严重的关切。该方法包括识别或定义健康结果的阈值,这些阈值对应于微不足道或没有,小,中等或较大的影响,并使用它们来评估不精确。它有助于在决策框架中使用证据,并为如何使用“审查信息大小”的概念和不同的基线风险解决不合理的大影响和微不足道或没有影响的不精确性提供指导。用实际例子说明了该方法,在线计算器和图形显示,可以应用于二分和连续的结果。
结论:在这篇等级指导文章中,我们提供了有关如何使用部分和完全上下文化的等级方法来评估不精确性的最新指南,以提出建议或决策,考虑替代基线风险,以及二分法和连续结果。
Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to rate the certainty domain of imprecision is presently not fully operationalized for rating down by two levels and when different baseline risk or uncertainty in these risks are considered. In addition, there are scenarios in which lowering the certainty of evidence by three levels for imprecision is more appropriate than lowering it by two levels. In this article, we conceptualize and operationalize rating down for imprecision by one, two and three levels for imprecision using the contextualized GRADE approaches and making decisions.
Through iterative discussions and refinement in online meetings and through email communication, we developed draft guidance to rating the certainty of evidence down by up to three levels based on examples. The lead authors revised the approach according to the feedback and the comments received during these meetings and developed GRADE guidance for how to apply it. We presented a summary of the results to all attendees of the GRADE Working Group meeting for feedback in October 2021 (approximately 80 people) where the approach was formally approved.
This guidance provides GRADE\'s novel approach for the considerations about rating down for imprecision by one, two and three levels based on serious, very serious and extremely serious concerns. The approach includes identifying or defining thresholds for health outcomes that correspond to trivial or none, small, moderate or large effects and using them to rate imprecision. It facilitates the use of evidence to decision frameworks and also provides guidance for how to address imprecision about implausible large effects and trivial or no effects using the concept of the \'review information size\' and for varying baseline risks. The approach is illustrated using practical examples, an online calculator and graphical displays and can be applied to dichotomous and continuous outcomes.
In this GRADE guidance article, we provide updated guidance for how to rate imprecision using the partially and fully contextualized GRADE approaches for making recommendations or decisions, considering alternate baseline risks and for both dichotomous and continuous outcomes.