gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

The challenges of using GRADE methodology with prognostic studies-a case study of managing an acute painful sickle cell episode in hospital

Meeting Abstract

  • A. Senthinathan - National Institute for Health and Clinical Excellence (NICE), Manchester, United Kingdom
  • T. Tan - National Institute for Health and Clinical Excellence (NICE), Manchester, United Kingdom
  • D. Jones - National Institute for Health and Clinical Excellence (NICE), Manchester, United Kingdom
  • P. Alderson - National Institute for Health and Clinical Excellence (NICE), Manchester, United Kingdom
  • E. McFarlane - National Institute for Health and Clinical Excellence (NICE), Manchester, United Kingdom

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP056

DOI: 10.3205/12gin168, URN: urn:nbn:de:0183-12gin1686

Veröffentlicht: 10. Juli 2012

© 2012 Senthinathan et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: GRADE (Grading of Recommendations Assessment, Development and Evaluation) provides a structured approach to presenting outcomes from systematic reviews addressing intervention and diagnostic questions and allows explicit judgements about the overall quality of the evidence. However, there is little guidance on how to use a GRADE-like approach for prognostic questions.

Aims: To present preliminary methods and challenges of applying a GRADE-like approach to address a prognostic question.

Methods: As part of a clinical guideline on managing acute painful sickle cell episodes in hospital, a systematic review was carried out to assess the use of clinical signs and symptoms and laboratory markers to predict acute complications. A review of the methods and challenges associated with adapting GRADE is discussed.

Results: In order to assess the quality of evidence to answer a prognostic question, criteria similar to those used in GRADE for diagnostic questions were applied. For example, 'risk of bias' was modified in terms of study design: prospective studies started with a 'high' quality rating and retrospective studies started with a 'low' quality rating. Therefore, similar to diagnostic questions, studies at low risk of bias were initially treated as high-quality evidence.

Discussion: Preliminary use of a modified GRADE system for prognostic studies was agreed by the Guideline Development Group. However, further work is needed in this area to ensure a standardised approach is taken.

Implications: A uniform approach to applying GRADE in the review of prognostic research would be valuable. Our preliminary work may be used as a basis for further development.