Using GRADE to respond to health questions with different levels of urgency |
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| Institution: | 1. Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC 27709, USA;2. Department of Clinical Epidemiology & Biostatistics, Department of Medicine, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada;1. Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia;2. School of Rehabilitation Science, McMaster University, Hamilton, Canada;3. Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia;4. Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia;5. Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia;6. Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt;7. Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa;8. McMaster Health Forum and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada;9. Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa;10. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada;1. Pharmacy Department/ Evidence-based Pharmacy Centre, West China Second University Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Disease of Women and Children, Ministry of Education, No. 20, Section 3, South Renmin Road, Chengdu, Sichuan, China, 610041;2. Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8;3. Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, SE-102 33, Stockholm, Sweden;4. Public Health Agency of Canada. 785 Carling Avenue, Ottawa, Ontario, Canada, K1A 0K9;5. Internal Medicine Service, German Hospital, Pueyrred_on 1640, Buenos Aires C1118AAT, Argentina;6. Department of Anesthesia, McMaster University, 1200 Main Street West Hamilton, Ontario, Canada, L8N 3Z5;7. Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4K1;8. Mayo Clinic Evidence-based Practice Center, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA 55905;9. Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, DK-2000 Copenhagen F, Denmark;10. Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark |
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| Abstract: | Increasing interest exists in applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to environmental health evidence. While ideally applied to evidence synthesized in systematic reviews and corresponding summary tables, such as evidence profiles, GRADE's correct application requires that “the evidence that was assessed and the methods that were used to identify and appraise that evidence should be clearly described.” In this article, we suggest that GRADE could be applied to evidence assembled from narrative reviews, modelled (indirect) evidence, or evidence assembled as part of a rapid response, if the underlying judgments about the certainty in this evidence are based on the relevant GRADE domains and provided transparently. Health questions that require assessing the certainty in a body of evidence to provide trustworthy answers may range from hours, to days or weeks, to a few months to scenarios that allow assessing evidence without short-term time pressures. Time frames of emergent, urgent or rapid evidence assessments will often require relying on existing summaries or rapidly compiling the available evidence and making assessments. Even without available full systematic reviews, expressing the certainty in the evidence can provide useful guidance for users of the evidence and those who evaluate certainty in effects. The ratings also help clarifying disagreement between organizations tackling similar questions about the evidence. Using the structured GRADE domains, narrative or other summaries of the evidence can be presented transparently. |
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