gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

An example of applying GRADE and an 'across studies' grading system in a guideline on asthma management in children: contrasting recommendations

Meeting Abstract

Suche in Medline nach

  • M. Langendam - The Dutch Cochrane Centre, Amsterdam, The Netherlands
  • N. Boluyt - Emma Children's Hospital/ Academic Medical Center, Amsterdam, The Netherlands
  • B. Rottier - Beatrix Children's Hospital/ University Medical Center, Groningen, The Netherlands

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP077

doi: 10.3205/12gin189, urn:nbn:de:0183-12gin1895

Veröffentlicht: 10. Juli 2012

© 2012 Langendam et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background Guideline developers use various systems to rate the quality of evidence underlying their recommendations. However, all have limitations. Therefore, a highly structured and transparent method was launched: GRADE.

Objectives: To compare a conventional 'across studies' grading system with the GRADE approach in a Dutch guideline on asthma management in children.

Methods: Both grading systems were applied to a controversial issue: what is the most effective and safe treatment in children with asthma symptoms despite inhaled corticosteroids (ICS): adding a long-acting beta-agonist (LABA) or double the dose of ICS?

Results: With the conventional grading system it was recommended to first add LABA in case of asthma symptoms. Using GRADE, the recommendation changed to first double the ICS dose instead of adding LABA (weak recommendation).

Discussion: The evidence underlying the recommendation was of very low quality and the balance between benefits and harms unclear. The evidence base was slightly different when applying the two systems, but this did not affect the ratings. To confirm the findings of this example a systematic approach is needed in a wider set of guidelines, including recommendations based on high quality evidence and/or clear balance between benefits and harms.

Implications for guideline developers/users: GRADE offers guideline developers/users a systematic and explicit approach in formulating evidence-based recommendations, which may lead to contrasting recommendations when compared to other grading systems.