GRADE Guidelines: 3. Rating the Quality of Evidence△_Chinese Journal of Evidence-Based Medicine

Authors：

Howard Balshem , Mark Helfanda , Holger J. Schunemann , Andrew D. Oxman , Regina Kunz , Jan Brozek , Gunn E. Vist , Yngve FalckYtter , Joerg Meerpohl , Susan Norris , Gordon H. Guyatt , 代表GRADE工作組

Corresponding?author：

Keywords：

質量評價; 證據群; 不精確性; 間接性; 不一致性; 發表偏倚

DOI：

10.7507/1672-2531.20110078

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本文介紹證據質量分級的GRADE方法。GRADE將證據質量分為高、中、低和極低四個級別。該分級應用于證據群，而非針對個別研究。系統評價中，質量反映了我們認為效應估計值正確的把握度。對推薦意見而言，質量反映了我們認為效應估計值足以支持某特定推薦的把握度。隨機對照試驗初定為高質量證據，觀察性研究初定為低質量證據。GRADE中所使用的質量一詞不只是意味著偏倚風險，還可能受研究結果的不精確性、不一致性和間接性，及發表偏倚的影響。此外，若干因素可增加我們對效應估計值的把握度。GRADE提供了一種系統方法來思考并報告各因素。GRADE將評估證據質量的過程與給出推薦建議的過程分開。推薦強度的判斷不僅依賴于證據質量。

Citation： Howard Balshem,Mark Helfanda,Holger J. Schunemann,Andrew D. Oxman,Regina Kunz,Jan Brozek,Gunn E. Vist,Yngve FalckYtter,Joerg Meerpohl,Susan Norris,Gordon H. Guyatt,代表GRADE工作組. GRADE Guidelines: 3. Rating the Quality of Evidence△. Chinese Journal of Evidence-Based Medicine, 2011, 11(4): 451-455. doi: 10.7507/1672-2531.20110078 Copy

1.	1 Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol , 2011, 64: 383-394.
2.	Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol , 2011, 64: 395-400.
3.	Guyatt GH, Oxman AD, Vist GE, et al . GRADE guidelines: 4. Rating the quality of evidencedstudy limitations (risk of bias). J Clin Epidemiol , 2011, 64: 407-415.
4.	Guyatt GH, Oxman AD, Montori V, et al . GRAD Eguidelines: 5. Rating the quality of evidence – publication bias. J Clin Epidemiol , In press.
5.	Guyatt GH, Oxman AD, Kunz R, et al . GRAD Eguidelines: 6.Rating the quality of evidence-imprecision (random error). J Clin Epidemiol , In press.
6.	Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: 7. Rating the quality of evidence-inconsistency. J Clin Epidemiol , In press.
7.	Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: 8. Rating the quality of evidence-indirectness. J Clin Epidemiol , In press.
8.	Waldman RJ, Hall WN, McGee H, et al . Aspirin as a risk factor in Reye’s syndrome. JAMA , 1982, 247: 3089-3094.
9.	Starko KM, Ray CG, Dominguez LB, et al . Reye’s syndrome and salicylate use. Pediatrics , 1980, 66: 859-864.
10.	Halpin TJ, Holtzhauer FJ, Campbell RJ, et al . Reye’s syndrome and medication use. JAMA , 1982, 248: 687-691.
11.	Hurwitz ES, Barrett MJ, Bregman D, et al . Public health service study of Reye’s syndrome and medications: report of the main study. JAMA , 1987, 257: 1905-1911.
12.	Kearon C, Gent M, Hirsh J, et al . A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med , 1999, 340: 901.
13.	Campbell IA, Bentley DP, Prescott RJ, et al . Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. BMJ , 2007, 334: 674.
14.	Kearon C, Ginsberg JS, Anderson DR, et al . Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor. J Thromb Haemost , 2004, 2: 743-749.
15.	Agnelli G, Prandoni P, Santamaria MG, et al . Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med , 2001, 345: 165.
16.	Guyatt GH, Oxman AD, Vist GE, et al . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ , 2008, 336: 924-926.

1. 1 Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol , 2011, 64: 383-394.
2. Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol , 2011, 64: 395-400.
3. Guyatt GH, Oxman AD, Vist GE, et al . GRADE guidelines: 4. Rating the quality of evidencedstudy limitations (risk of bias). J Clin Epidemiol , 2011, 64: 407-415.
4. Guyatt GH, Oxman AD, Montori V, et al . GRAD Eguidelines: 5. Rating the quality of evidence – publication bias. J Clin Epidemiol , In press.
5. Guyatt GH, Oxman AD, Kunz R, et al . GRAD Eguidelines: 6.Rating the quality of evidence-imprecision (random error). J Clin Epidemiol , In press.
6. Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: 7. Rating the quality of evidence-inconsistency. J Clin Epidemiol , In press.
7. Guyatt GH, Oxman AD, Kunz R, et al . GRADE guidelines: 8. Rating the quality of evidence-indirectness. J Clin Epidemiol , In press.
8. Waldman RJ, Hall WN, McGee H, et al . Aspirin as a risk factor in Reye’s syndrome. JAMA , 1982, 247: 3089-3094.
9. Starko KM, Ray CG, Dominguez LB, et al . Reye’s syndrome and salicylate use. Pediatrics , 1980, 66: 859-864.
10. Halpin TJ, Holtzhauer FJ, Campbell RJ, et al . Reye’s syndrome and medication use. JAMA , 1982, 248: 687-691.
11. Hurwitz ES, Barrett MJ, Bregman D, et al . Public health service study of Reye’s syndrome and medications: report of the main study. JAMA , 1987, 257: 1905-1911.
12. Kearon C, Gent M, Hirsh J, et al . A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med , 1999, 340: 901.
13. Campbell IA, Bentley DP, Prescott RJ, et al . Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial. BMJ , 2007, 334: 674.
14. Kearon C, Ginsberg JS, Anderson DR, et al . Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor. J Thromb Haemost , 2004, 2: 743-749.
15. Agnelli G, Prandoni P, Santamaria MG, et al . Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med , 2001, 345: 165.
16. Guyatt GH, Oxman AD, Vist GE, et al . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ , 2008, 336: 924-926.

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