1 / 11

Considerations in grading a recommendation

Considerations in grading a recommendation. methodological quality of evidence likelihood of bias trade-off between benefits and risks. Methodological quality specific to an outcome. benefits often have RCTS risks often limited to observational studies. Possible levels of quality.

rea
Download Presentation

Considerations in grading a recommendation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Considerations in grading a recommendation • methodological quality of evidence • likelihood of bias • trade-off between benefits and risks

  2. Methodological quality specific to an outcome • benefits • often have RCTS • risks • often limited to observational studies

  3. Possible levels of quality • strong • intermediate • weak • very weak

  4. Quality of evidence,Where to start? • basic study design • randomized trials • strong evidence • observational studies • weak evidence

  5. Downgrading quality,weak implementation • detailed design and execution • concealment • balance in known prognostic factors • intention to treat principle observed • blinding • completeness of follow-up

  6. Downgrading qualityinconsistency • evidence weaker if results differ from study to study • subjective judgement • you will be told

  7. Downgrading quality, indirectness • indirect treatment comparisons • interested in A versus B • have A versus C and B versus C • different patient population • different intervention • different outcome

  8. Downgrading quality, reporting bias, sparse data • what if you have a biased sample of studies? • publication bias • what if one study with 10 people?

  9. What can increase strength of evidence? • large association can upgrade • very large, 2 levels • large with no plausible confounders, 1 level • dose-response gradient • can upgrade one level

  10. Grade of Recommendations • do it or don’t do it • strong recommendation • probably do it, or probably don’t • weaker recommendation

  11. Risk/Benefit tradeoff • seriousness of outcome • magnitude of effect • precision of treatment effect • risk of target event • risk of adverse events • cost of therapy • values and preferences

More Related