Can we trust strong recommendations based on low quality evidence?
Can we trust strong recommendations based on low quality evidence?
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我们可以相信基于低质量证据的强有力的建议吗？
DOI：
10.1136/bmj.n2833
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Djulbegovic,Benjamin
中科院分区：
文献类型：
--
作者：
Yao,Liang;Guyatt,GordonH;Djulbegovic,Benjamin
制定可信准则的一个必要要求是尊重证据的质量(确定性)和建议的力度之间的关系。强有力的建议在基于高质量证据的情况下是合理的，因为这样的建议被认为更准确。1另一方面，利益和危害的不确定性(即低质量的证据)通常会导致较弱的建议。未能认识到这一重要原则会导致基于低质量证据(我们称之为不一致的建议)提出强有力的建议的倾向，往往会导致伤害。例如，根据低质量证据的建议，妇女经历了为预防心血管疾病而开出的激素替代疗法可以避免的不良影响；患有乳腺癌的妇女接受了剧毒干细胞移植，但没有受益。这种将证据质量与建议力度脱钩的做法通常是合理的，将准则分为协商一致准则和基于证据的准则--这种做法似乎不会随着时间的推移而减少。
A necessary requirement for development of trustworthy guidelines is to respect the relation between the quality (certainty) of evidence and strength of recommendations. Strong recommendations are justified when they are based on high quality evidence, because such recommendations are considered more accurate. 1 On the other hand, uncertainty in benefits and harms (that is, low quality evidence) generally leads to weaker recommendations.The failure to recognise this important principle results in a tendency to issue strong recommendations based on low quality evidence (which we call discordant recommendations), often leading to harm. For instance, based on advice from low quality evidence, women have experienced avoidable adverse effects from hormone replacement therapy prescribed for the prevention of cardiovascular disease; and women with breast cancer have undergone highly toxic stem cell transplantation without benefit. This practice of decoupling the quality of evidence from the strength of recommendations is usually justified by separating guidelines into consensus guidelines versus evidence based guidelines—a practice that does not appear to have abated over time.