What is “quality of evidence” and why is it important to clinicians?
BMJPublished 1 May 2008Open access
Gordon Guyatt, Andrew D Oxman, Regina Kunz, Gunn Elisabeth Vist, Yngve Falck–Ytter, Holger J. Schünemann
Citations3,247
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Guideline developers use a bewildering variety of systems to rate the quality of the evidence underlying their recommendations, some facile, some confused, and others sophisticated but complex.
Abstract
Guideline developers use a bewildering variety of systems to rate the quality of the evidence underlying their recommendations. Some are facile, some confused, and others sophisticated but complex
Keywords
Decision SciencesMedicineHealth Professions
BMJGrading quality of evidence and strength of recommendations
8,465 Citations2004David C. Atkins, Dana Best +25 more
A system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts is developed, and a summary of the approach from the perspective of a guideline user is presented.
JAMAUsers' guides to the medical literature
2,981 Citations1993Gordon Guyatt
A 55-year-old man who had his serum cholesterol level measured at a shopping mall 2 months ago has an elevated cholesterol level, but before deciding on a treatment recommendation, you elect to find out just how big a reduction in the risk of CHD this patient could expect from a cholesterollowering diet or drug therapy.
BMJSimultaneous comparison of multiple treatments: combining direct and indirect evidence
1,610 Citations2005Deborah M Caldwell, A. E. Ades +1 more
Comparisons of three or more treatments, based on pair-wise or multi-arm comparative studies, as a multiple treatment comparison evidence structure to determine the best treatment are described.
Annals of Internal MedicineBetter Reporting of Harms in Randomized Trials: An Extension of the CONSORT Statement
1,522 Citations2004John P. A. Ioannidis, Stephen J.W. Evans +6 more
This work searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library using a wide array of terms related to harms and identified pertinent evidence and made recommendations on the appropriate reporting of harms in RCTs.
Users' guides to the medical literature : a manual for evidence-based clinical practice
1,192 Citations2002Gordon Guyatt, Drummond Rennie +2 more
The third edition of this landmark resource is now completely revised and refreshed throughout, with expanded coverage of both basic and advanced issues in using evidence-based medicine in clinical practice.
CirculationThromboembolic and bleeding complications in patients with mechanical heart valve prostheses.
1,063 Citations1994Suzanne C. Cannegieter, F.R. Rosendaal +1 more
The incidence of bleeding became significantly higher with the addition of antiplatelet therapy, although this did not decrease the risk of thromboembolism any further.
JAMAUsers' Guides to the Medical Literature
742 Citations2000Gordon H. Guyatt, Robert Haynes +7 more
This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients to relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine.
PubMedRandomized trials stopped early for benefit: a systematic review.
696 Citations2005Víctor M. Montori, P.J. Devereaux +20 more
RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small, which suggests clinicians should view the results of such trials with skepticism.
American Journal of Respiratory and Critical Care MedicineAn Official ATS Statement: Grading the Quality of Evidence and Strength of Recommendations in ATS Guidelines and Recommendations
580 Citations2006Holger J. Schünemann, Roman Jaeschke +15 more
This article informs ATS guideline developers, investigators, and those interpreting future A TS guidelines that follow the GRADE approach about the methodology and applicability of ATS guidelines and recommendations.
BMJWhen are randomised trials unnecessary? Picking signal from noise
571 Citations2007Paul Glasziou, Iain Chalmers +2 more
A list of historical examples of dramatic effects and the features of convincing inferences about treatment effects from sources other than randomised trials are identified, which may help to reduce controversy about evidence for treatments whose effects are so dramatic that randomised Trials are unnecessary.
PubMedCompleteness of safety reporting in randomized trials: an evaluation of 7 medical areas.
568 Citations2001John P. A. Ioannidis, Joseph Lau
Current standards for safety reporting in randomized trials should be revised to address this inadequacy, as generalizable data on drug safety reporting are sparse and largely inadequate.
Cochrane Database of Systematic ReviewsHelmets for preventing head and facial injuries in bicyclists
545 Citations1999Diane C. Thompson, Fred Rivara +1 more
This review identified five well conducted case control studies which met the selection criteria and identified Helmets provide a 63%-88% reduction in the risk of head, brain and severe brain injury for all ages of bicyclists.
CHEST JournalHemorrhagic Complications of Anticoagulant Treatment
513 Citations2004Mark N. Levine, Gary E. Raskob +3 more
There is good evidence that vitamin K antagonist therapy, targeted international normalized ratio (INR) of 2.5 (range, 2.0 to 3.0), is associated with a lower risk of bleeding than therapy targeted at an INR >3.0.
PubMedGuidelines for reading literature reviews.
495 Citations1988Andrew D Oxman, Gordon Guyatt
New guidelines that will help readers assess the scientific quality of the review are proposed and will allow clinicians to spend their valuable reading time on high-quality material and to judge the validity of an author's conclusions.
BMJDifferences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational studyCommentary: Varied preferences reflect the reality of clinical practice
418 Citations2001P.J. Devereaux, Tom Fahey +7 more
Physicians' and patients' thresholds for how much reduction in risk of stroke is necessary and how much risk of excess bleeding is acceptable with antithrombotic treatment in people with atrial fibrillation are determined and compared.
Scandinavian Journal of Work Environment & HealthQuality of evidence
344 Citations2003Tim Carter
It is indicated that rapid searches of biomedical databases can provide useful support for clinical decisions in occupational health, but the author would be seriously concerned about the very real limitations of this approach in an area such as occupational health.
BIBSYS Brage (BIBSYS (Norway))Improving the Use of Research Evidence in Guideline Development
261 Citations2007Andrew D Oxman, Holger J. Schünemann +4 more
The series of articles being published in Health Research Policy and Systems, which examine the methods used by WHO and other organisations to formulate recommendations about health, is part of the background documentation SURE has produced to inform ACHR's advice to WHO.
JAMAComparison of Mortality Between Private For-Profit and Private Not-For-Profit Hemodialysis Centers
183 Citations2002P.J. Devereaux, Holger J. Schünemann +13 more
The pooled estimate demonstrated that private for-profit dialysis centers were associated with an increased risk of death and suggested that there are annually 2500 excessive premature deaths in US for- Profit dialysis Centers.
Annals of Internal MedicineBrief Communication: Better Ways To Question Patients about Adverse Medical Events
177 Citations2006Stephen Bent, Amy Padula +1 more
A randomized, controlled trial to determine whether different methods of identifying adverse events in a clinical trial would lead to different estimates of the frequency of these events.
British journal of surgeryMeta-analysis of flavonoids for the treatment of haemorrhoids
170 Citations2006Pablo Alonso‐Coello, Qi Zhou +5 more
The aim of the study was to evaluate the impact of flavonoids on those symptoms important to patients with symptomatic haemorrhoids.
Health Research Policy and SystemsImproving the use of research evidence in guideline development: 10. Integrating values and consumer involvement
164 Citations2006Holger J. Schünemann, Atle Fretheim +1 more
All WHO guideline groups should uniformly apply explicit, transparent and clearly described methods for integrating values, and WHO should develop a checklist for guidelines panels to help them to ensure that ethical considerations relevant to recommendations are addressed explicitly and transparently.
Thrombosis and HaemostasisProspective Randomised Open-label Comparison of Danaparoid with Dextran 70 in the Treatment of Heparin-induced Thrombocytopaenia with Thrombosis
158 Citations2001Beng H. Chong, J. F. Cade +11 more
D danaparoid plus warfarin treatment for HIT with thrombosis is effective, safe, and superior to dextran 70 plus Warfarin.
Evidence-Based MedicinePatients at the centre: in our practice, and in our use of language
152 Citations2004Gordon Guyatt
Drug SafetyImproving Safety Reporting from Randomised Trials
100 Citations2002John P. A. Ioannidis, Joseph Lau
The use of standardised scales for adverse effects is a prerequisite for improved reporting on safety in randomised trials and electronic publication, publication of raw databases, large database research, meta-analytic approaches, and prospective registration of clinical trials and of their databases may further improve the safety insights the authors can gain from randomised clinical trials.
Annals of Surgical OncologyThe Pylorus: Take It or Leave It? Systematic Review and Meta-Analysis of Pylorus-Preserving versus Standard Whipple Pancreaticoduodenectomy for Pancreatic or Periampullary Cancer
83 Citations2007Paul J. Karanicolas, Edward T. Davies +10 more
Moderate-quality evidence suggests PPPD is a faster procedure with less blood loss compared with SWPD, and large absolute differences in other key outcomes are unlikely; excluding relatively small differences will, however, require larger, methodologically stronger trials.
Medical Decision MakingPreference-Based Antithrombotic Therapy in Atrial Fibrillation: Implications for Clinical Decision Making
74 Citations2005Malcolm Man‐Son‐Hing, Brian F. Gage +8 more
The thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines were compared.
Annals of Internal MedicineApproach of the Canadian Task Force to the Periodic Health Examination
28 Citations1980Suzanne W. Fletcher, Walter O. Spitzer
The Canadian Task Force on the Periodic Health Examination, discussed by Delbanco and Taylor in the preceding editorial, is the most recent of a growing number of publ...
