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工作组

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Keywords：

质量评价; 证据群; 不精确性; 间接性; 不一致性; 发表偏倚

DOI：

10.7507/1672-2531.20110078

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本文介绍证据质量分级的GRADE方法。GRADE将证据质量分为高、中、低和极低四个级别。该分级应用于证据群，而非针对个别研究。系统评价中，质量反映了我们认为效应估计值正确的把握度。对推荐意见而言，质量反映了我们认为效应估计值足以支持某特定推荐的把握度。随机对照试验初定为高质量证据，观察性研究初定为低质量证据。GRADE中所使用的质量一词不只是意味着偏倚风险，还可能受研究结果的不精确性、不一致性和间接性，及发表偏倚的影响。此外，若干因素可增加我们对效应估计值的把握度。GRADE提供了一种系统方法来思考并报告各因素。GRADE将评估证据质量的过程与给出推荐建议的过程分开。推荐强度的判断不仅依赖于证据质量。

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工作组. 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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