GRADE Flashcards
What is GRADE?
A process used to assess the quality of the science of one or more RCTs
- all tried to answer the same question and were randomized when chosen
What are the 5 aspects that GRADE examines?
- Risk of bias
- Inconsistency
- Indirectness
- Imprecision
- Publication bias
What is a Systemic Review (SR)?
- draws conclusions about effectiveness of intervention (estimate of the effect)
- how believable conclusions are based on quality of study (certainty of evidence)
Risk of Bias
Examines items relating to randomization, allocation concealment, blinding, selective outcome reporting, and other CONSORT items
- is scored from low risk of bias, unclear risk, or high risk
Inconsistency
Refers to unexplained inconsistency of results —> individual RCTs within a body of evidence yield very different estimates of effect
- the quality of evidence is downgraded if there is no plausible explanation
- downgrade includes; large difference between means
Indirectness
Focuses on PICO:
Patients - research conducted in populations in hope to provide answers for
Interventions - RCTs include the interested interventions
Comparisons - compare interventions with appropriate controls or alternatives
Outcomes - outcomes of interest have actually been measured, rather than something else that may or may not be informative (poor surrogates)
Imprecision
Considers:
1. Confidence intervals
- small CI = precise estimate of treatment effect
- large CI = imprecise estimate (uncertainty in treatment effect)
2. Sample size
- optimal info size (OIS)
- downgrade if total participants in SR is less than a sample size calculation for a single adequate study
3. Number of events
- sufficient # of participants, but not enough events to measure —> sample size may need to be based on number of events
Public Bias
Funnel plots and other methods can be used to assess the likelihood that some of the evidence has withheld/not published/ ignored
