Evolution of evidence grading and recommendation system for evidence-based guidelines_West China Medical Journal

Authors：

ZHANG Dingding ,  ZHU Yicheng

Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, P. R. China;

Corresponding author：

ZHU Yicheng, Email: zhuych910@163.com

Keywords：

Evidence-based guidelines; evidence grading; recommendation strength

DOI：

10.7507/1002-0179.202405140

Video：

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Evidence grading and recommendation strength assessment are key steps in the development of evidence-based guidelines, and have made significant progress in recent years. This article systematically reviews the development and evolution of evidence grading and recommendation strength in the past 30 years, and introduces the main representative standards. At the same time, a brief introduction is given to the guidelines and consensus evaluation results published in the field of neurological diseases in China, and future improvements are proposed. This article aims to help readers understand the development patterns of evidence grading and recommendation strength, in order to better understand the guidelines, and to develop more standardized guidelines.

Citation： ZHANG Dingding, ZHU Yicheng. Evolution of evidence grading and recommendation system for evidence-based guidelines. West China Medical Journal, 2024, 39(5): 677-680. doi: 10.7507/1002-0179.202405140 Copy

1.	蒋朱明, 詹思延, 贾晓巍, 等. 制订/修订《临床诊疗指南》的基本方法及程序. 中华医学杂志, 2016, 96(4): 250-253.
2.	陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022 版). 中华医学杂志, 2022, 102(10): 697-703.
3.	Glasziou P, Vandenbroucke JP, Chalmers I. Assessing the quality of research. BMJ, 2004, 328(7430): 39-41.
4.	陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
5.	Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J, 1979, 121(9): 1193-1254.
6.	Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest, 1986, 89(2 Suppl): 2S-3S.
7.	Agency for Health Care Policy and Research. Clinical Practice Guideline No. 1: acute pain management: operative or medical procedures and trauma. Rockville, MD: US Department of Health and Human Services, 1992.
8.	Eccles M, Clapp Z, Grimshaw J, et al. North of England evidence based guidelines development project: methods of guideline development. BMJ, 1996, 312(7033): 760-762.
9.	USPSTF. U. S. Preventive Services Task Force procedure manual. Rockville, MD: U. S. Preventive Services Task Force, 2021.
10.	丁泓帆, 杨楠, 邓围, 等. WHO 指南制定的基本原则和方法. 中国循证医学杂志, 2016, 16(4): 471-477.
11.	中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南 2010. 中华神经科杂志, 2010, 14(35): 146-153.
12.	OCEBM Levels of Evidence Working Group. The 2011 Oxford CEBM evidence levels of evidence. Oxford: Oxford Centre for Evidence-Based Medicine, 2011.
13.	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
14.	刘鸣, 张苏明, 郝子龙. 中国急性缺血性卒中诊治指南 2010 版的制定及解读. 中华神经科杂志, 2011, 44(6): 369-374.
15.	Steiner T, Dichgans M, Norrving B, et al. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J, 2021, 6(3): CXXII-CXXXIV.
16.	Ntaios G, Bornstein NM, Caso V, et al. The European Stroke Organisation Guidelines: a standard operating procedure. Int J Stroke, 2015, 10(Suppl A100): 128-135.
17.	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
18.	卫茂玲, 刘鸣. 中国临床指南循证制定的方法学现状分析. 中国循证医学杂志, 2013, 13(8): 927-932.
19.	杨楠, 赵巍, 潘旸, 等. 针对临床实践指南科学性、透明性和适用性的评级工具研发. 中华医学杂志, 2022, 102(30): 2329-2337.
20.	中华医学会杂志社指南与标准研究中心, 中国医学科学院循证评价与指南研究创新单元, 世界卫生组织指南实施与知识转化合作中心. 2021 年医学期刊发表中国指南和共识的科学性、透明性和适用性的评级. 中华医学杂志, 2022, 102(30): 2319-2328.
21.	中华医学会杂志社指南与标准研究中心, 中国医学科学院循证评价与指南研究创新单元, 世界卫生组织指南实施与知识转化合作中心, STAR 工作组. 2022 年医学期刊发表中国指南和共识的科学性、透明性和适用性的评级. 中华医学杂志, 2023, 103(37): 2912-2920.
22.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南 2022. 中华神经科杂志, 2022, 55(6): 565-580.
23.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国缺血性卒中和短暂性脑缺血发作二级预防指南 2022. 中华神经科杂志, 2022, 55(10): 1071-1110.

1. 蒋朱明, 詹思延, 贾晓巍, 等. 制订/修订《临床诊疗指南》的基本方法及程序. 中华医学杂志, 2016, 96(4): 250-253.
2. 陈耀龙, 杨克虎, 王小钦, 等. 中国制订/修订临床诊疗指南的指导原则(2022 版). 中华医学杂志, 2022, 102(10): 697-703.
3. Glasziou P, Vandenbroucke JP, Chalmers I. Assessing the quality of research. BMJ, 2004, 328(7430): 39-41.
4. 陈耀龙, 李幼平, 杜亮, 等. 医学研究中证据分级和推荐强度的演进. 中国循证医学杂志, 2008, 8(2): 127-133.
5. Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J, 1979, 121(9): 1193-1254.
6. Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest, 1986, 89(2 Suppl): 2S-3S.
7. Agency for Health Care Policy and Research. Clinical Practice Guideline No. 1: acute pain management: operative or medical procedures and trauma. Rockville, MD: US Department of Health and Human Services, 1992.
8. Eccles M, Clapp Z, Grimshaw J, et al. North of England evidence based guidelines development project: methods of guideline development. BMJ, 1996, 312(7033): 760-762.
9. USPSTF. U. S. Preventive Services Task Force procedure manual. Rockville, MD: U. S. Preventive Services Task Force, 2021.
10. 丁泓帆, 杨楠, 邓围, 等. WHO 指南制定的基本原则和方法. 中国循证医学杂志, 2016, 16(4): 471-477.
11. 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南 2010. 中华神经科杂志, 2010, 14(35): 146-153.
12. OCEBM Levels of Evidence Working Group. The 2011 Oxford CEBM evidence levels of evidence. Oxford: Oxford Centre for Evidence-Based Medicine, 2011.
13. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328(7454): 1490.
14. 刘鸣, 张苏明, 郝子龙. 中国急性缺血性卒中诊治指南 2010 版的制定及解读. 中华神经科杂志, 2011, 44(6): 369-374.
15. Steiner T, Dichgans M, Norrving B, et al. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines. Eur Stroke J, 2021, 6(3): CXXII-CXXXIV.
16. Ntaios G, Bornstein NM, Caso V, et al. The European Stroke Organisation Guidelines: a standard operating procedure. Int J Stroke, 2015, 10(Suppl A100): 128-135.
17. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
18. 卫茂玲, 刘鸣. 中国临床指南循证制定的方法学现状分析. 中国循证医学杂志, 2013, 13(8): 927-932.
19. 杨楠, 赵巍, 潘旸, 等. 针对临床实践指南科学性、透明性和适用性的评级工具研发. 中华医学杂志, 2022, 102(30): 2329-2337.
20. 中华医学会杂志社指南与标准研究中心, 中国医学科学院循证评价与指南研究创新单元, 世界卫生组织指南实施与知识转化合作中心. 2021 年医学期刊发表中国指南和共识的科学性、透明性和适用性的评级. 中华医学杂志, 2022, 102(30): 2319-2328.
21. 中华医学会杂志社指南与标准研究中心, 中国医学科学院循证评价与指南研究创新单元, 世界卫生组织指南实施与知识转化合作中心, STAR 工作组. 2022 年医学期刊发表中国指南和共识的科学性、透明性和适用性的评级. 中华医学杂志, 2023, 103(37): 2912-2920.
22. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南 2022. 中华神经科杂志, 2022, 55(6): 565-580.
23. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国缺血性卒中和短暂性脑缺血发作二级预防指南 2022. 中华神经科杂志, 2022, 55(10): 1071-1110.

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