Chapter 22 – Using Systematic Reviews in Guideline Development: the GRADE Approach

Holger J. Schünemann

Abstract

Systematic reviews are essential to produce trustworthy guidelines. To assess the body of evidence included in a systematic review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group has developed an approach that is used by over 100 organizations, including the World Health Organization and Cochrane. GRADE provides operational definitions and instructions to rate the certainty of the evidence for each outcome in a review as high, moderate, low, or very low for interventions, prognostic questions, values and preferences, test accuracy, and resource utilization. GRADE includes assessing risk of bias, imprecision, inconsistency, indirectness, and publication bias, the magnitude of effects, dose–response relations, and the impact of residual confounding and bias. Assessments are presented in GRADE tables, which may be produced using the GRADEpro software tool. Guideline panels can use these tables to produce recommendations based on the GRADE Evidence to Decision frameworks.

Corrections

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Resources

22.3 Developing recommendations and making decisions.
Example of a detailed EtD framework:

Supplemental-Table Download

The GRADE Online Learning Modules offers links to a series of free webinars on the different factors considered in GRADE. The interested reader can choose the subject they want to focus on and learn more.

Practicals

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Author affiliations

Holger J. Schünemann

Department of Health Research, Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, Ontario, Canada

How to cite this chapter?

For the printed version of the book

Schünemann, H.J. (2022). Chapter 22. Using systematic reviews in guideline development: the GRADE approach. In: Systematic Reviews in Health Research: Meta-analysis in Context (eds M. Egger, J.P.T. Higgins and G. Davey Smith), pp 424-448. Hoboken, NJ : Wiley.