From the Trenches A Cross-Sectional Study Applying the GRADE Tool in Systematic Reviews of Healthcare Interventions 英文参考文献.docVIP

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From the Trenches A Cross-Sectional Study Applying the GRADE Tool in Systematic Reviews of Healthcare Interventions 英文参考文献.doc

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From the Trenches A Cross-Sectional Study Applying the GRADE Tool in Systematic Reviews of Healthcare Interventions 英文参考文献

FromtheTrenches:ACross-SectionalStudyApplyingthe GRADEToolinSystematicReviewsofHealthcare Interventions LisaHartling1,2*,RicardoM.Fernandes3,JenniferSeida1,BenVandermeer1,DonnaM.Dryden1 1DepartmentofPediatrics,AlbertaResearchCentreforHealthEvidence,UniversityofAlberta,Edmonton,Canada,2DepartmentofPediatrics,CochraneChildHealth Field,UniversityofAlberta,Edmonton,Alberta,Canada,3GulbenkianProgrammeforAdvancedMedicalEducation;Departamento daCrianc?a edaFam?′lia(Childand Family Department), Hospital de Santa Maria; Laborato′rio de Farmacologia Cl?′nica e Terape?utica (Clinical Pharmacology and Therapeutics), Instituto de Medicina Molecular,Lisboa,Portugal Abstract Background:GRADEwasdevelopedtoaddressshortcomingsoftoolstoratethequalityofabodyofevidence.Whilemuch hasbeenpublishedaboutGRADE,therearefewempiricalandsystematicevaluations. Objective:ToassessGRADEforsystematicreviews(SRs)intermsofinter-rateragreementandidentifyareasofuncertainty. Design:Cross-sectional,descriptivestudy. Methods:WeappliedGRADEtothreeSRs(n=48,66,and75studies,respectively)with29comparisonsand12outcomes overall. Two reviewers graded evidence independently for outcomes deemed clinically important a priori. Inter-rater reliabilitywasassessedusingkappasforfourmaindomains(riskofbias,consistency,directness,andprecision)andoverall qualityofevidence. Results:Forthefirstreview,reliabilitywas:k=0.41forriskofbias;0.84consistency;0.18precision;and0.44overallquality. Kappacouldnotbecalculatedfordirectnessasoneraterassessedallitemsasdirect;assessorsagreedin41%ofcases.For the second review reliability was: 0.37 consistency and 0.19 precision. Kappa could not be assessed for other items; assessorsagreedin33%ofcasesforriskofbias;100%directness;and58%overallquality.Forthethirdreview,reliability was: 0.06 risk of bias; 0.79 consistency; 0.21 precision; and 0.18 overall quality. Assessors agreed in 100% of cases for directness.Precisioncreatedthemostuncertaintyduetodifficultiesinidentifying‘‘optimal’’infor