How to Understand and Use GRADE System Correctly? A Briefly Outline_Chinese Journal of Evidence-Based Medicine

Authors：

ZENG Xiantao ¹ , LENG Weidong ^1,2 , LI Sheng ³ ,  GUO Yi ^4,5 , WANG Pu ⁶

1. Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China;2. School of Stomatology, Hubei University of Medicine, Shiyan 442000, China;3. Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China;;

Corresponding author：

GUO Yi, Email: guoyius@yahoo.com

Keywords：

Evidence; Evidence-Based Medcine; GRADE System; GRADEpro 3.2 Software; Level of Evidence; Strength of Recommendation

DOI：

10.7507/1672-2531.20110165

Video：

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Evidence is the core of Evidence-Based Medcine; the Grades of Recommendations Assessment, Development and Evaluation (GRADE System) is a milestone in the history of evidence development. This paper outlines the GRADE System and GRADEpro 3.2 software, and briefly explores the right and wrong application which was published in the Chinese Journal of Evidence-Based Medicine. The GRADEpro 3.2 software is easy to operate, but for evaluating the reasons of upgrade and downgrade, and the importance of the parameters of outcomes, it needs to comprehensively and systematically understand the knowledge of relevant background, and to construct a solid foundation in clinical epidemiology and systematic review. In view of this paper based on the current GRADE System, there may be some discrepancy to the later content with the GRADE System constant improvement. Therefore, it is bly recommended that readers should keep constant learning and improving.

Citation： ZENG Xiantao,LENG Weidong,LI Sheng,GUO Yi,WANG Pu. How to Understand and Use GRADE System Correctly? A Briefly Outline. Chinese Journal of Evidence-Based Medicine, 2011, 11(9): 985-990. doi: 10.7507/1672-2531.20110165 Copy

1.	1 Atkins D, Best D, Briss PA, et al . Grading quality of evidence and strength of recommendations. BMJ , 2004, 328(7454): 1490.
2.	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.
3.	Guyatt GH, Oxman AD, Vist GE, 等. GRADE: 证据质量和推荐强度分级的共识. 陈佩贤，陈耀龙，译. 中国循证医学杂志, 2009, 9(1): 8-11.
4.	Guyatt GH, Oxman AD, Kunz R, 等. GRADE: 什么是“证据质量”？为什么它对临床医生重要？陈柳，陈耀龙, 译. 中国循证医学杂志, 2009, 9(2): 133-137.
5.	Guyatt GH, Oxman AD, Kunz R, 等. GRADE: 从证据到推荐. 谭培勇, 陈耀龙, 译. 中国循证医学杂志, 2009, 9(3): 257-259.
6.	Schünemann HJ, Oxman AD, Brozek J, 等. 诊断性试验和策略的证据质量和推荐强度的分级. 李晓, 黄程, 陈耀龙, 译. 中国循证医学杂志, 2009, 9(5): 503-508.
7.	Guyatt GH, Oxman AD, Kunz R, 等. GRADE: 在推荐分级中体现对资源利用的考虑. 王菊芬, 陈耀龙, 译. 中国循证医学杂志, 2009, 9(6): 610-613.
8.	Guyatt G, Oxman AD, Akl E, 等. GRADE 指南: Ⅰ. 导论——GRADE 证据概要表和结果总结表. 杨晓妍, 蒋兰慧, 沈建通, 译. 中国循证医学杂志, 2011, 11(4): 437-445.
9.	Guyatt GH, Oxman AD, Kunz R, 等. GRADE 指南: Ⅱ. 构建问题、确定重要结果. 陈群飞, 译. 中国循证医学杂志, 2011, 11(4): 446-450.
10.	Balshem H, Helfanda M, Schunemann HJ, 等. GRADE指南: Ⅲ. 证据质量分级. 高霑, 译. 中国循证医学杂志, 2011, 11(4): 451-455.
11.	Guyatt GH, Oxman AD, Vist G, 等. GRADE指南: Ⅳ. 证据质量分级——研究的局限性（偏倚风险）. 李鸿浩, 李玲, 译. 中国循证医学杂志, 2011, 11(4): 456-463.
12.	李幼平, 主编. 循证医学. 第2版. 北京: 高等教育出版社, 2009: 24-29.
13.	刘鸣, 主编. 系统评价、Meta-分析设计与实施方法. 北京: 人民卫生出版社, 2011: 136-138.
14.	黄志华, 屠蕊沁, 吴利俊. 良性疾病全子宫切除术不同微创术式间比较的系统评价. 中国循证医学杂志, 2010, 10(3): 323-338.
15.	王朴, 郭毅, 张君梅, 等. 运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价. 中国循证医学杂志, 2011, 11(5): 529-539.
16.	GRADEpro. [Computer program]. Version 3.2 for Windows. Jan Brozek, Andrew Oxman, Holger Schünemann, 2008.
17.	Jaeschke R, Guyatt GH, Dellinger P, et al . Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ , 2008, 337: a744.
18.	郭毅. 循证决策模拟案例分析. 公共卫生与预防医学, 2007, 18(4): 1-3.

1. 1 Atkins D, Best D, Briss PA, et al . Grading quality of evidence and strength of recommendations. BMJ , 2004, 328(7454): 1490.
2. 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.
3. Guyatt GH, Oxman AD, Vist GE, 等. GRADE: 证据质量和推荐强度分级的共识. 陈佩贤，陈耀龙，译. 中国循证医学杂志, 2009, 9(1): 8-11.
4. Guyatt GH, Oxman AD, Kunz R, 等. GRADE: 什么是“证据质量”？为什么它对临床医生重要？陈柳，陈耀龙, 译. 中国循证医学杂志, 2009, 9(2): 133-137.
5. Guyatt GH, Oxman AD, Kunz R, 等. GRADE: 从证据到推荐. 谭培勇, 陈耀龙, 译. 中国循证医学杂志, 2009, 9(3): 257-259.
6. Schünemann HJ, Oxman AD, Brozek J, 等. 诊断性试验和策略的证据质量和推荐强度的分级. 李晓, 黄程, 陈耀龙, 译. 中国循证医学杂志, 2009, 9(5): 503-508.
7. Guyatt GH, Oxman AD, Kunz R, 等. GRADE: 在推荐分级中体现对资源利用的考虑. 王菊芬, 陈耀龙, 译. 中国循证医学杂志, 2009, 9(6): 610-613.
8. Guyatt G, Oxman AD, Akl E, 等. GRADE 指南: Ⅰ. 导论——GRADE 证据概要表和结果总结表. 杨晓妍, 蒋兰慧, 沈建通, 译. 中国循证医学杂志, 2011, 11(4): 437-445.
9. Guyatt GH, Oxman AD, Kunz R, 等. GRADE 指南: Ⅱ. 构建问题、确定重要结果. 陈群飞, 译. 中国循证医学杂志, 2011, 11(4): 446-450.
10. Balshem H, Helfanda M, Schunemann HJ, 等. GRADE指南: Ⅲ. 证据质量分级. 高霑, 译. 中国循证医学杂志, 2011, 11(4): 451-455.
11. Guyatt GH, Oxman AD, Vist G, 等. GRADE指南: Ⅳ. 证据质量分级——研究的局限性（偏倚风险）. 李鸿浩, 李玲, 译. 中国循证医学杂志, 2011, 11(4): 456-463.
12. 李幼平, 主编. 循证医学. 第2版. 北京: 高等教育出版社, 2009: 24-29.
13. 刘鸣, 主编. 系统评价、Meta-分析设计与实施方法. 北京: 人民卫生出版社, 2011: 136-138.
14. 黄志华, 屠蕊沁, 吴利俊. 良性疾病全子宫切除术不同微创术式间比较的系统评价. 中国循证医学杂志, 2010, 10(3): 323-338.
15. 王朴, 郭毅, 张君梅, 等. 运动想象疗法对脑卒中后患者上肢运动功能康复效果的系统评价. 中国循证医学杂志, 2011, 11(5): 529-539.
16. GRADEpro. [Computer program]. Version 3.2 for Windows. Jan Brozek, Andrew Oxman, Holger Schünemann, 2008.
17. Jaeschke R, Guyatt GH, Dellinger P, et al . Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ , 2008, 337: a744.
18. 郭毅. 循证决策模拟案例分析. 公共卫生与预防医学, 2007, 18(4): 1-3.

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