英文1.GRADE：证据质量和推荐强度分级的共识.docxVIP

ANALYSIS Rating quality of evidence and strength of recommendations GRADE: an emerging consensus on rating quality of evidence and strength of recommendations Guidelines are inconsistent in how they rate the quality of evidence and the strength of recommendations. This article explores the advantages of the GRADE system, which is increasingly being adopted by organisations worldwide Guideline developers around the world are inconsist-ent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face challenges in understanding the messages that grading systems try to communicate. Since 2006 the BMJ has requested in its “Instructions to Authors” on that authors should preferably use the Grading of Recommendations Assessment, Develop-ment and Evaluation (GRADE) system for grading evidence when submitting a clinical guidelines article. What was behind this decision? In this first in a series of five articles we will explain why many organisations use formal systems to grade evidence and recommendations and why this is important for clinicians; we will focus on the GRADE approach to recommendations. In the next two articles we will examine how the GRADE system categorises quality of evidence and strength of recommendations. The final two articles will focus on recommendations for diagnostic tests and GRADE’s framework for tack-ling the impact of interventions on use of resources. GRADE has advantages over previous rating systems (box 1). Other systems share some of these advantages, but none, other than GRADE, combines them all.1 What is “quality of evidence” and why is it important? In making healthcare management decisions, patients and clinicians must weigh up the benefits and down-sides of alternative strategies. Decision makers will be influenced not only by the best estimates of the expected Box 1 | Advantages of GRADE over other systems Developed by a widely representative group of international guideline developers