Grade Methodology - Surviving Sepsis Campaign

Grading of Recommendations Assessment, Development and Evaluation (GRADE) Methodology
Strength of Evidence
BMJ2008;336:924
Downgradingand Upgrading Evidence
RCT
Poor quality of planning and implementationInconsistencyof resultsIndirectnessof evidenceImprecisionofresultsHighlikelihood of reportingbias
ObservationalStudies
Start with“low-quality”ratingMagnitudeofeffectis very largeDose-responserelationAllplausible biases would decreasemagnitudeofapparenttreatment effect
Strength of Recommendation
StrongRecommendwhen virtually all informed patients would choose the same management strategyWeak (conditional)Suggestimply that choices will differ across the range of patient values and preferences
Factors ThatInfluenceStrength of Recommendation