Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable
Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable
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DOI：
10.1016/j.jclinepi.2014.01.006
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发表时间：
2014-07-01
影响因子：
7.2
通讯作者：
Langendam, Miranda W.
中科院分区：
文献类型：
--
作者：
Gopalakrishna, Gowri;Mustafa, Reem A.;Langendam, Miranda W.
目标：建议分级评估、发展和评价（GRADE）工作组制定了一种评估诊断试验证据质量的方法。它在Cochrane诊断测试准确性评价中的应用是新的。我们将这种方法应用于3篇Cochrane综述，目的是更好地理解GRADE标准在这些综述中的应用。研究设计和环境：我们选择综述来实现临床和方法的多样性。至少有三名评估员根据GRADE的偏倚、间接、不精确、不一致和发表偏倚风险标准独立评估每篇综述。举行了两次电话会议以分享经验。结果：对于GRADE标准的解释，评估者是从患者重要结果的角度来看证据还是从测试准确性的角度来看证据是有区别的。GRADE标准，如不一致、不精确和发表偏倚，与比较试验准确性评价一样具有挑战性。结论：证据分级的角度会影响对证据质量的判断。关于GRADE在比较试验评价中的应用以及关于不一致、不精确和发表偏倚的GRADE标准的指导将促进GRADE在诊断中的应用。(C) 2014年作者。Elsevier Inc.出版。版权所有。
Objectives: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group developed an approach to assess the quality of evidence of diagnostic tests. Its use in Cochrane diagnostic test accuracy reviews is new. We applied this approach to three Cochrane reviews with the aim of better understanding the application of the GRADE criteria to such reviews.Study Design and Setting: We selected reviews to achieve clinical and methodological diversities. At least three assessors independently assessed each review according to the GRADE criteria of risk of bias, indirectness, imprecision, inconsistency, and publication bias. Two teleconferences were held to share experiences.Results: For the interpretation of the GRADE criteria, it made a difference whether assessors looked at the evidence from a patient-important outcome perspective or from a test accuracy standpoint. GRADE criteria such as inconsistency, imprecision, and publication bias were challenging to apply as was the assessment of comparative test accuracy reviews.Conclusion: The perspective from which evidence is graded can influence judgments about quality. Guidance on application of GRADE to comparative test reviews and on the GRADE criteria of inconsistency, imprecision, and publication bias will facilitate the operationalization of GRADE for diagnostics. (C) 2014 The Authors. Published by Elsevier Inc. All rights reserved.