GRADE guidelines: 22. The GRADE approach for tests and strategies-from test accuracy to patient-important outcomes and recommendations.

Select Content Type
Clinical Guidelines
Authored By
Schünemann HJ, Mustafa RA, Brozek J, Santesso N, Bossuyt PM, Steingart KR, Leeflang M, Lange S, Trenti T, Langendam M, Scholten R, Hooft L, Murad MH, Jaeschke R, Rutjes A, Singh J, Helfand M, Glasziou P, Arevalo-Rodriguez I, Akl EA, Deeks JJ, Guyatt GH
Authored On
Interests
Emergency Medicine
Speciality
Emergency Medicine
Book Detail
volume
111
ISSN
1878-5921
Publication Date
Actions
Download in App
Event Data
{"article_title":"GRADE guidelines: 22. The GRADE approach for tests and strategies-from test accuracy to patient-important outcomes and recommendations.","author":"Sch\u00fcnemann HJ, Mustafa RA, Brozek J, Santesso N, Bossuyt PM, Steingart KR, Leeflang M, Lange S, Trenti T, Langendam M, Scholten R, Hooft L, Murad MH, Jaeschke R, Rutjes A, Singh J, Helfand M, Glasziou P, Arevalo-Rodriguez I, Akl EA, Deeks JJ, Guyatt GH","journal_title":"Journal of clinical epidemiology","issn":"1878-5921","isbn":"","publication_date":"2019-07-01","volume":"111","issue":"","first_page":"69","page_count":"","accession_number":"30738926","doi":"10.1016\/j.jclinepi.2019.02.003","publisher":"Elsevier","doctype":"Journal Article","subjects":"GRADE Approach; Outcome Assessment, Health Care methods; Outcome Assessment, Health Care standards; Humans","interest_area":["Emergency Medicine"],"abstract":"Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence. Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences. Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can-and often does-lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making. Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use. Copyright \u00a9 2019. Published by Elsevier Inc.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=30738926","isPdfLink":false,"isSAML":false,"an":"30738926","number_other":"","type_pub":"","issn_electronic":"1878-5921","languages":"English","language":"eng","date_entry":"Date Created: 20190211 Date Completed: 20200521 Latest Revision: 20200521","date_update":"20240105","titleSource":"Journal of clinical epidemiology [J Clin Epidemiol] 2019 Jul; Vol. 111, pp. 69-82. Date of Electronic Publication: 2019 Feb 07.","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2019-07-01","description":"Objectives: This article describes the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group's framework of moving from test accuracy to patient or population-important outcomes. We focus on the common scenario when studies directly evaluating the effect of diagnostic and other tests or strategies on health outcomes are not available or are not providing the best available evidence.<br \/>Study Design and Setting: Using practical examples, we explored how guideline developers and other decision makers can use information from test accuracy to develop a recommendation by linking evidence that addresses downstream consequences. Guideline panels should develop an analytic framework that summarizes the actions that follow from applying a test and the consequences.<br \/>Results: We describe GRADE's current thinking about the overall certainty of the evidence (also known as quality of the evidence or confidence in the estimates) arising from consideration of the often complex pathways that involve multiple tests and management options. Each link in the evidence can-and often does-lower the overall certainty of the evidence required to formulate recommendations and make decisions about tests. The frequency with which an outcome occurs and its importance will influence whether or not a particular step in the linked evidence is critical to decision-making.<br \/>Conclusions: Overall certainty may be expressed by the weakest critical step in the linked evidence. The linked approach to addressing optimal testing will often require the use of decision analytic approaches. We present an example that involves decision modeling in a GRADE Evidence to Decision framework for cervical cancer screening. However, because resources and time of guideline developers may be limited, we describe alternative, pragmatic strategies for developing recommendations addressing test use.<br \/> (Copyright © 2019. Published by Elsevier Inc.)","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&scope=site&db=mdl&AN=30738926&authtype=shib&custid=ns346513&group=main&profile=eds","no_of_pages":"","authored_by":"Sch\u00fcnemann HJ, Mustafa RA, Brozek J, Santesso N, Bossuyt PM, Steingart KR, Leeflang M, Lange S, Trenti T, Langendam M, Scholten R, Hooft L, Murad MH, Jaeschke R, Rutjes A, Singh J, Helfand M, Glasziou P, Arevalo-Rodriguez I, Akl EA, Deeks JJ, Guyatt GH"}
ISSN
1878-5921
IS_Ebsco
true
Published Date