Meerpohl Joerg J, Langer Gero, Perleth Matthias, Gartlehner Gerald, Kaminski-Hartenthaler Angela, Schünemann Holger
Deutsches Cochrane Zentrum, Institut für Medizinische Biometrie und Medizinische Informatik, Universitätsklinikum FreiburgundKlinik IV.
Z Evid Fortbild Qual Gesundhwes. 2012;106(6):449-56. doi: 10.1016/j.zefq.2012.06.013. Epub 2012 Jul 6.
This article introduces the GRADE approach to rating the quality of evidence. GRADE specifies four categories (high, moderate, low, and very low) that are applied to a body of evidence, not to individual studies. In the context of a systematic review, quality reflects our confidence that the estimates of the effect are correct. In the context of recommendations, quality reflects our confidence that the effect estimates are adequate to support a particular recommendation. Randomised trials begin as high quality evidence, observational studies as low quality. "Quality" as used in GRADE means more than risk of bias and so may also be compromised by imprecision, inconsistency, indirectness of study results, and publication bias. In addition, several factors can increase our confidence in an estimate of effect. GRADE provides a systematic approach for considering and reporting each of these factors. GRADE separates the process of assessing quality of evidence from the process of making recommendations. Judgments about the strength of a recommendation depend on more than just the quality of evidence.
本文介绍了用于评估证据质量的GRADE方法。GRADE规定了应用于一组证据而非个别研究的四个类别（高、中、低和极低）。在系统评价的背景下，质量反映了我们对效应估计正确的信心。在推荐的背景下，质量反映了我们对效应估计足以支持特定推荐的信心。随机试验一开始是高质量证据，观察性研究是低质量证据。GRADE中使用的“质量”含义不仅包括偏倚风险，因此也可能因不精确性、不一致性、研究结果的间接性和发表偏倚而受到影响。此外，几个因素可以增加我们对效应估计的信心。GRADE提供了一种系统方法来考虑和报告这些因素中的每一个。GRADE将评估证据质量的过程与提出推荐的过程分开。关于推荐强度的判断不仅仅取决于证据质量。
