Guyatt Gordon, Agoritsas Thomas, Brignardello-Petersen Romina, Mustafa Reem A, Rylance Jamie, Foroutan Farid, Prasad Manya, Agarwal Arnav, De Beer Hans, Murad M Hassan, Schandelmaier Stefan, Iorio Alfonso, Yao Liang, Jaeschke Roman, Vandvik Per Olav, Zeng Linan, Parpia Sameer, D'Souza Rohan, Rind David, Chu Derek K, Eachempati Prashanti, Prasad Kameshwar, Hultcrantz Monica, Montori Victor M
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada.
BMJ. 2025 Apr 22;389:e081903. doi: 10.1136/bmj-2024-081903.
This first article in a seven part series presents an overview of the essential elements of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach that has proved extremely useful in systematic reviews, health technology assessment reports, and clinical practice guidelines. GRADE guidance has appeared in many articles dealing with both core issues and more specialised and complex guidance, and it has evolved over time. This series of articles presents GRADE essentials, Core GRADE, focusing on the core judgments necessary to summarise the comparative evidence about alternative care options and to make recommendations that apply to the care of individual patients. This article presents detailed guidance on formulating questions using the PICO (population, intervention, comparison, outcome) structure, and refining the question considering possible differences in relative and absolute effects across patient groups. The article then provides an overview of the remainder of the Core GRADE approach, including decisions about the certainty of the evidence and considerations in moving from evidence to guidance and recommendations.
本系列共七篇文章中的第一篇，概述了GRADE（推荐分级评估、制定与评价）方法的基本要素，该方法在系统评价、卫生技术评估报告及临床实践指南中已证明极为有用。GRADE指南已出现在许多涉及核心问题以及更专业复杂指南的文章中，且随着时间不断演变。本系列文章介绍GRADE要点，即核心GRADE，重点关注总结替代护理方案比较证据及提出适用于个体患者护理建议所需的核心判断。本文提供了关于使用PICO（人群、干预措施、对照、结局）结构提出问题，并考虑不同患者群体相对和绝对效应可能存在的差异来完善问题的详细指南。然后，本文概述了核心GRADE方法的其余部分，包括关于证据确定性的决策以及从证据到指南和建议过程中的考量。
