Chu Derek K, Golden David B K, Guyatt Gordon H
Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada.
Department of Medicine, Division of Allergy-Immunology, Johns Hopkins University, Baltimore, Md.
J Allergy Clin Immunol Pract. 2021 Dec;9(12):4221-4230. doi: 10.1016/j.jaip.2021.09.035. Epub 2021 Oct 5.
Optimal evidence-based clinical practice requires systematic summaries of the best available evidence, including ratings of the quality of that evidence, and is facilitated by the availability of trustworthy guidelines. In this review, we describe the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rating quality of evidence and moving from evidence to recommendations using examples from allergy-immunology. GRADE focuses on systematic summaries of the best evidence, systematic reviews and trustworthy guidelines, and emphasizes a structured approach to determining quality (certainty) of bodies of evidence, absolute magnitude of effects of desirable and undesirable consequences (benefits and harms), and use of evidence to develop clinical recommendations. Adopted by over 110 organizations worldwide, including the American Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters, GRADE is foundational to the optimal interpretation of research evidence and its application in clinical practice. This review supports the clinician's ability to find and use the information in GRADE guidelines to help care for patients in the clinic.
最佳的循证临床实践需要对现有最佳证据进行系统总结,包括对该证据质量的评级,而可信的指南有助于实现这一点。在本综述中,我们使用过敏免疫学的实例,描述推荐分级、评估、制定与评价(GRADE)方法,以对证据质量进行评级并从证据得出推荐意见。GRADE关注最佳证据的系统总结、系统评价和可信指南,并强调采用结构化方法来确定证据体的质量(确定性)、期望和非期望结果(益处和危害)的绝对效应量,以及利用证据制定临床推荐意见。GRADE被全球110多个组织采用,包括美国过敏、哮喘与免疫学会/美国过敏、哮喘与免疫学院实践参数联合工作组,它是对研究证据进行最佳解读并将其应用于临床实践的基础。本综述有助于临床医生查找并使用GRADE指南中的信息,以在临床中帮助护理患者。