Brignardello-Petersen Romina, Guyatt Gordon H
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Am J Epidemiol. 2025 Jun 3;194(6):1681-1686. doi: 10.1093/aje/kwae332.
When interpreting results and drawing conclusions, authors of systematic reviews should consider the limitations of the evidence included in their review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach provides a framework for the explicit consideration of the limitations of the evidence included in a systematic review, and for incorporating this assessment into the conclusions. Assessments of certainty of evidence are a methodological expectation of systematic reviews. The certainty of the evidence is specific to each outcome in a systematic review and can be rated as high, moderate, low, or very low. Because it will have an important impact, before assessing the certainty of evidence, reviewers must clarify the intent of their question: are they interested in causation or association. Serious concerns regarding limitations in the study design, inconsistency, imprecision, indirectness, and publication bias can decrease the certainty of the evidence. Using an example, this article describes and illustrates the importance and the steps for assessing the certainty of evidence and drawing accurate conclusions in a systematic review.
在解释结果并得出结论时，系统评价的作者应考虑其评价中所纳入证据的局限性。推荐分级评估、制定与评价（GRADE）方法提供了一个框架，用于明确考虑系统评价中所纳入证据的局限性，并将这一评估纳入结论之中。对证据确定性的评估是系统评价的一项方法学要求。证据的确定性针对系统评价中的每个结局而言，可被评为高、中、低或极低。由于这会产生重要影响，在评估证据的确定性之前，评价者必须明确其问题的意图：他们关注的是因果关系还是关联。对研究设计的局限性、不一致性、不精确性、间接性和发表偏倚的严重担忧会降低证据的确定性。本文通过一个例子描述并说明了在系统评价中评估证据确定性并得出准确结论的重要性及步骤。
