GRADE (Grading of Recommendations, Assessment, Development and Evalua-tion): “근거수준(Quality of Evidence)” 이란 무엇이며, 임상의사에게 왜 중요한가?
Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: What Is “Quality of Evidence” and Why Is It Important to Clinicians?’ (A Secondary Publication)
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This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evi-dence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation(GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, impre-cision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘low’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.
Abstract
This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evi-dence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation(GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, impre-cision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘low’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.
참고문헌 (12)
- Atkins D, "Grading quality of evidence and strength of recommendations", BMJ, 328, pp.1490~ (2004)
- Guyatt GH, "GRADE Working Group. What is “quality of evidence” and why is it important to clinicians?", BMJ, 336, pp.995~998 (2008)
- Oxman AD, "Guidelines for reading literature reviews", CMAJ, 138, pp.697~703 (1988)
- Schunemann HJ, "Improving the use of research evidence in guideline development: 10. integratingvalues and consumer involvement", Health Res Policy Syst, 4, pp.22~ (2006)
- Fletcher SW, "Approach of the Canadian task force to the periodic health examination", Ann Intern Med, 92, pp.253~254 (1980)
- Schunemann HJ, "ATS Documents Development and Implementation Committee. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations", Am J Respir Crit Care Med, 174, pp.605~614 (2006)
- Guyatt G, "Users’ guides to the medical literature: a manual for evidence-based clinical practice" (2002), American Medical Association
- Montori VM, "Randomized trials stopped early for benefit : a systematic review", JAMA, 294, pp.2203~2209 (2005)
- Karanicolas PJ, "The pylorus : take it or leave it? Systematic review and meta-analysis of pylorus-preserving versus standard whipple pancreaticoduodenectomy for pancreatic or periampullary cancer", Ann Surg Oncol, 14, pp.1825~1834 (2007)
- Glasziou P, "When are randomised trials unnecessary? Picking signal from noise", BMJ, 334, pp.349~351 (2007)
- Thompson DC, "Helmets for preventing head and facial injuries in bicyclists", Cochrane Database Syst Rev, 2, pp.CD001855~ (2000)
- Cannegieter SC, "Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses", Circulation, 89, pp.635~641 (1994)