Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Plataforma INVEST Medicina UANL - KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico.
Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Plataforma INVEST Medicina UANL - KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; Research Unit, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico.
J Clin Epidemiol. 2020 Jul;123:180-188.e2. doi: 10.1016/j.jclinepi.2020.02.010. Epub 2020 Mar 4.
The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) working group has recognized some scenarios in which strong recommendations may be supported by low-quality evidence, the so-called paradigmatic situations. The adherence to these paradigmatic situations by the American Thyroid Association (ATA) guidelines, however, remains unknown.
Clinical guidelines from the ATA were retrieved and deemed eligible if created using GRADE or the American College of Physicians (ACP) system. Reviewers, independently and in duplicate, assessed all strong recommendations based on low-quality evidence and judged their alignment with GRADE paradigmatic situations. The study was conducted at KER Unit Mexico.
A total of five clinical guidelines, one using the GRADE and four using the ACP system, were eligible for analysis. We assessed a total of 518 recommendations, of which 355 (69%) were labeled as "strong" and 163 (31%) as "weak". A total of 151 strong recommendations were based on low-quality evidence, of which 36 (24%) were congruent with one of the five GRADE paradigmatic situations, whereas 115 (76%) were not consistent with any paradigmatic situations and should have been categorized as weak (23% [26/115]) or best-practice recommendations (77% [89/115]).
ATA clinical guidelines are discordant with GRADE guidance. Future guidelines should carefully evaluate the quality of evidence and recognize its limitations when developing recommendations.
推荐分级评估、制定与评价（GRADE）工作组已经认识到一些情况下，低质量证据可能支持强烈推荐，这些情况被称为典型情况。然而，美国甲状腺协会（ATA）指南是否遵循这些典型情况仍不清楚。
检索了 ATA 的临床指南，如果是使用 GRADE 或美国医师学院（ACP）系统制定的，则被认为符合条件。审查员独立并重复地评估了所有基于低质量证据的强烈推荐，并判断它们与 GRADE 典型情况的一致性。该研究在 KER 墨西哥单位进行。
共有五项临床指南符合条件，其中一项使用 GRADE，四项使用 ACP 系统。我们评估了总共 518 项建议，其中 355 项（69%）被标记为“强烈”，163 项（31%）为“弱”。总共 151 项强烈推荐是基于低质量证据的，其中 36 项（24%）与 GRADE 的五个典型情况之一一致，而 115 项（76%）与任何典型情况都不一致，本应归类为弱（23% [26/115]）或最佳实践推荐（77% [89/115]）。
ATA 临床指南与 GRADE 指南不一致。未来的指南在制定建议时应仔细评估证据的质量并认识到其局限性。
