Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
Michael G. De Groote Cochrane Canada and McMaster GRADE centres, Department of Health Research Methods, Evidence, and Impact, 1280 Main Street West, McMaster University, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, U.S.
J Clin Epidemiol. 2021 Aug;136:146-156. doi: 10.1016/j.jclinepi.2021.04.001. Epub 2021 Apr 20.
This article provides GRADE guidance on how authors of evidence syntheses and health decision makers, including guideline developers, can rate the certainty across a body of evidence for comparative test accuracy questions.
This guidance extends the previously published GRADE guidance for assessing certainty of evidence for test accuracy to scenarios in which two or more index tests are compared. Through an iterative brainstorm-discussion-feedback process within the GRADE working group, we developed a guidance accompanied by practical examples.
Rating the certainty of evidence for comparative test accuracy shares many concepts and ideas with the existing GRADE guidance for test accuracy. The rating in comparisons of test accuracy requires additional considerations, such as the selection of appropriate comparative study designs, additional criteria for judging risk of bias, and the consequences of using comparative measures of test accuracy. Distinct approaches to rating certainty are required for comparative test accuracy studies and between-study (indirect) comparisons.
This GRADE guidance will support transparent assessment of the certainty for a body of comparative test accuracy evidence.
本文为证据综合作者和卫生决策者（包括指南制定者）提供了 GRADE 指导，以针对比较检验准确性问题对证据体的确定性进行评级。
本指导将之前发布的 GRADE 评估检验准确性证据确定性的指导扩展到了比较两种或多种诊断测试的情况。通过 GRADE 工作组内的迭代头脑风暴讨论反馈过程，我们制定了一份指导意见，并附有实际示例。
对比较检验准确性的证据进行评级与现有的 GRADE 检验准确性指导意见有许多共同的概念和想法。在比较检验准确性的评级中，需要考虑其他因素，如选择适当的比较研究设计、用于判断偏倚风险的附加标准，以及使用比较检验准确性衡量标准的后果。对比较检验准确性研究和研究间（间接）比较的确定性评级需要采用不同的方法。
本 GRADE 指导将支持对比较检验准确性证据体的确定性进行透明评估。
