gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

New developments in GRADE

Meeting Abstract

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  • R. Jaeschke - McMaster University, Ontario, Canada

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocPL02

doi: 10.3205/12gin003, urn:nbn:de:0183-12gin0036

Veröffentlicht: 10. Juli 2012

© 2012 Jaeschke.
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.



12 years ago a group of guideline developers, public health officers, clinicians, epidemiologists, policy makers and other scientists reacted to the confusion caused by the existence of multiple systems to evaluate the quality of evidence (aka levels of evidence or strength of evidence) and to develop recommendations by deciding to develop, test and implement a new and potentially universal one. The defining features of the resulting GRADE approach were a’priori specification of outcomes critical for a given recommendation, judging the quality of evidence (QoE) on an individual outcome level, separating QoE from the strength of recommendation and consideration of all criteria that are relevant for making recommendations [1]. Much work has taken place...

The new development and innovations in GRADE are illustrated by number of processes which took place during recent CPG work. Those included:

changes in the process (attention to the intellectual or financial conflict of interest; leading roles for unconflicted methodologist from outside of professional societies
explicit distinction between patient-important and surrogate outcomes
specification of values and preferences
changes in the scope (increasing attention to diagnostic issues)
changes in the presentation of evidence: preparation of evidence profiles
ongoing close ‘as you go’ collaboration of interested methodologists and clinicians;
exclusion of conflicting experts, explicit presentation of evidence and recognition of variability in values and preferences led to frequent weak rather than strong recommendation;

Future challenges:

training of sufficient number of individuals serving as GRADE resource person; planning for the future updates and reiterations (succession plans);
training of sufficient number of content area experts in GRADE methodology (rise and usefulness of webinars);
continuous struggle to link the recommendations to evidence.


Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr, Zaza S. Grading quality of evidence and strength of recommendations. BMJ. 2004 Jun;328(7454):1490. DOI: 10.1136/bmj.328.7454.1490 Externer Link