Western Michigan University, MI, USA.
Eval Health Prof. 2010 Sep;33(3):233-55. doi: 10.1177/0163278710373980.
Over the past 30 years, a general consensus has emerged within the medical community regarding the essential role served by grading guidelines in evaluating the quality of evidence produced by a medical research study. Specifically, consensus exists regarding the hierarchy of evidence, where randomized controlled trials (RCTs) are considered the ''gold standard'' followed by nonrandomized controlled trials (non-RCTs) and uncontrolled trials. As guidelines have become more sophisticated, processes have been developed for downgrading poorly conducted studies and upgrading strong studies. Lists of threats to internal validity have been disseminated, thereby assisting reviewers in grading studies. However, despite these many accomplishments, considerable issues remain unresolved with respect to how to evaluate the strength of evidence produced by flawed RCTs versus well-conducted non-RCTs. The purpose of this article is to evaluate existing evidence-based grading guidelines and to offer suggestions for how such guidelines may be improved.
在过去的 30 年里，医学界已经达成了一个共识，即分级指南在评估医学研究产生的证据质量方面起着至关重要的作用。具体来说，对于证据的等级划分，已经达成了共识，其中随机对照试验（RCT）被认为是“金标准”，其次是非随机对照试验（non-RCT）和非对照试验。随着指南变得更加复杂，已经开发出了降级不良研究和升级强研究的流程。内部有效性威胁的清单已经得到了传播，从而帮助审查员对研究进行分级。然而，尽管取得了这些许多成就，但在如何评估有缺陷的 RCT 和精心设计的 non-RCT 产生的证据强度方面，仍存在许多悬而未决的问题。本文的目的是评估现有的循证分级指南，并就如何改进这些指南提出建议。
