Artikel
An example of applying GRADE and an 'across studies' grading system in a guideline on asthma management in children: contrasting recommendations
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Veröffentlicht: | 10. Juli 2012 |
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Gliederung
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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.