Online citations, reference lists, and bibliographies.
← Back to Search

Grading Strength Of Recommendations And Quality Of Evidence In Clinical Guidelines: Report From An American College Of Chest Physicians Task Force.

G. Guyatt, D. Gutterman, M. Baumann, D. Addrizzo-Harris, E. Hylek, B. Phillips, G. Raskob, S. Lewis, H. Schünemann
Published 2006 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
While grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical guidelines, the profusion of guideline grading systems undermines the value of the grading exercise. An American College of Chest Physicians (ACCP) task force formulated the criteria for a grading system to be utilized in all ACCP guidelines that included simplicity and transparency, explicitness of methodology, and consistency with current methodological approaches to the grading process. The working group examined currently available systems, and ultimately modified an approach formulated by the international GRADE group. The grading scheme classifies recommendations as strong (grade 1) or weak (grade 2), according to the balance among benefits, risks, burdens, and possibly cost, and the degree of confidence in estimates of benefits, risks, and burdens. The system classifies quality of evidence as high (grade A), moderate (grade B), or low (grade C) according to factors that include the study design, the consistency of the results, and the directness of the evidence. For all future ACCP guidelines, The College has adopted a simple, transparent approach to grading recommendations that is consistent with current developments in the field. The trend toward uniformity of approaches to grading will enhance the usefulness of practice guidelines for clinicians.
This paper references
10.1378/CHEST.126.3_SUPPL.401S
Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
H. Büller (2004)
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)
W. Cao (1996)
10.1378/CHEST.129.1.182
Addressing resource allocation issues in recommendations from clinical practice guideline panels: suggestions from an American College of Chest Physicians task force.
G. Guyatt (2006)
10.1378/CHEST.112.2.370
Economic analysis of respiratory rehabilitation.
R. Goldstein (1997)
10.1378/CHEST.126.3_SUPPL.311S
Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
T. Warkentin (2004)
10.1136/bmj.323.7323.1218
Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study.
P. Devereaux (2001)
10.1016/S0022-5223(95)70309-8
Long-term results of valve replacement with the St. Jude Medical prosthesis.
E. Baudet (1995)
Grading recommendations : a qualitative approach
G Guyatt
A randomised, blinded, trial of Clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)
D. Clément (1996)
10.1001/JAMA.287.10.1301
Corticosteroid therapy in pulmonary sarcoidosis: a systematic review.
Shanthi Paramothayan (2002)
10.1378/CHEST.126.3_SUPPL.338S
Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
W. Geerts (2004)
10.1378/CHEST.126.3_SUPPL.609S
Antithrombotic therapy in peripheral arterial occlusive disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
G. Clagett (2004)
10.1136/ebm.9.1.6
Patients at the centre: in our practice, and in our use of language
G. Guyatt (2004)
10.1161/01.STR.30.3.484
Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis.
S. D. de Bruijn (1999)
10.1378/chest.128.5.3775
Prevention of venous thromboembolism.
W. Geerts (2005)
10.1378/CHEST.126.3_SUPPL.457S
Antithrombotic therapy in valvular heart disease--native and prosthetic: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
D. Salem (2004)
10.1136/bmj.328.7454.1490
Grading quality of evidence and strength of recommendations
D. Atkins (2004)
A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.
P. Devereaux (2002)
10.1136/ebm.9.2.39
Patients at the centre: in our practice, and in our use of language
D. Goldfarb (2004)
10.1378/CHEST.102.4_SUPPLEMENT.516S
Antithrombotic therapy in peripheral arterial occlusive disease.
G. Clagett (1992)
10.1378/CHEST.119.1_SUPPL.176S
Antithrombotic therapy for venous thromboembolic disease.
T. Hyers (1986)
10.1002/14651858.cd001431.pub4
Decision aids for people facing health treatment or screening decisions.
A. O'connor (2003)
10.1136/bmj.313.7058.652
Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomised trials
R. Collins (1996)
10.1055/S-0037-1616046
Prospective randomised open-label comparison of danaparoid with dextran 70 in the treatment of heparin-induced thrombocytopaenia with thrombosis: a clinical outcome study.
B. Chong (2001)



This paper is referenced by
10.1093/pch/pxx023
Management of term infants at increased risk for early-onset bacterial sepsis.
A. Jefferies (2017)
The use of pulsed radiofrequency in the management of chronic lumbosacral radicular pain
K. V. Boxem (2014)
10.1016/B978-1-4377-2220-8.00014-3
Complications of Facet Joint Injections and Medial Branch Blocks
Jason E. Pope (2012)
10.1503/cjs.001411
Management of chest tubes after pulmonary resection: a systematic review and meta-analysis.
S. M. Coughlin (2012)
10.1097/DCR.0b013e31828cb66c
Practice parameters for the management of rectal cancer (revised).
J. Monson (2013)
10.1007/978-3-319-65936-7
Vascular Surgery
George Geroulakos (2018)
10.1007/s00113-016-0283-0
Volumentherapie beim schwerverletzten Traumapatienten
Sigune Kaske (2016)
Consensus Statement for Early Reperfusion and Pharmaco-invasive Approach in Patients Presenting with Chest Pain Diagnosed as STEMI ( ST elevation myocardial infarction ) in an Indian Setting Developed in collaboration with STEMI India
J. Dalal (2014)
10.1210/jc.2007-2458
Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion
G. August (2008)
10.1590/S1677-54492009000200002
A terapia da compressão e sua evidência científica
M. Figueiredo (2009)
Efectividad del uso de suplementos de proteína en entrenamientos de fuerza: Revisión sistemática
Ana Lilia Armendariz-Anguiano (2010)
10.3265/NEFROLOGIA.PRE2011.AUG.11012
Impacto económico del tratamiento con vitamina D en pacientes con enfermedad renal crónica
R. Ramos (2011)
10.3324/haematol.2008.001743
International recommendations on the diagnosis and treatment of patients with acquired hemophilia A
A. Huth-Kuehne (2009)
Profilaxis Antibiótica en el Politraumatizado. Guías 2011 elaboradas por los comités de Infectología Crítica y de Trauma de la Sociedad Argentina de Terapia Intensiva (SATI)
R. Reina (2011)
10.1097/BRS.0b013e3181b778b2
Health Related Quality of Life Assessment in Metastatic Disease of the Spine: A Systematic Review
J. Street (2009)
Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature.
M. Rupert (2009)
10.1097/SLA.0000000000004029
Management Considerations for the Surgical Treatment of Colorectal Cancer During the Global Covid-19 Pandemic.
M. O'Leary (2020)
10.1111/resp.12643
Chipping away at duration of therapy for idiopathic acute eosinophilic pneumonia
J. Heffner (2015)
10.1371/journal.pone.0207410
A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: Implications for research and policy decision-making
Amy Johnston (2018)
10.1007/s12630-013-0020-x
The difficult airway with recommendations for management – Part 2 – The anticipated difficult airway
J. A. Law (2013)
10.1111/cen.12824
Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee
O. Okosieme (2016)
10.1590/S0004-282X2012000100012
Treatment of neuromyelitis optica: an evidence based review.
D. Sato (2012)
10.1016/j.ccm.2008.03.012
Treatment of sarcoidosis.
R. Baughman (2008)
10.1111/JOMS.12003
The Mutation of Professionalism as a Contested Diffusion Process: Clinical Guidelines as Carriers of Institutional Change in Medicine
P. Adler (2013)
10.1097/AJP.0000000000000351
Randomized Sham-controlled Double-Blind Multicenter Clinical Trial to Ascertain the Effect of Percutaneous Radiofrequency Treatment for Sacroiliac Joint Pain
C. W. van Tilburg (2016)
10.1093/annonc/mdu385
ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†
F. Cardoso (2014)
10.2147/JPR.S172419
The impact of prophylactic dexamethasone on postoperative sore throat: an updated systematic review and meta-analysis
Yaofei Jiang (2018)
10.1007/s00482-012-1216-7
[Treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients : a review].
G. Benze (2012)
10.1007/978-1-84996-492-0_50
Optimal Surgical Approach and Extent of Resection of the Thymus in Patients with Myasthenia Gravis
M. Magee (2011)
10.1007/978-1-84996-492-0_14
Optimal Therapy for Patients with Marginal Lung Function and Peripheral Stage I Lung Cancer
G. Varela (2011)
10.4018/978-1-60960-561-2.CH701
eHealth and Ethics
D. Whitehouse (2011)
10.1017/S0266462307070456
Establishing a comprehensive continuum from an evidentiary base to policy development for health technologies: the Ontario experience.
L. Levin (2007)
See more
Semantic Scholar Logo Some data provided by SemanticScholar