Quality of evidence is a key determinant for making a strong GRADE guidelines recommendation

Benjamin Djulbegovic; Ambuj Kumar; Richard M Kaufman; Aaron Tobian; Gordon H Guyatt

doi:10.1016/j.jclinepi.2014.12.015

Quality of evidence is a key determinant for making a strong GRADE guidelines recommendation

J Clin Epidemiol. 2015 Jul;68(7):727-32. doi: 10.1016/j.jclinepi.2014.12.015. Epub 2015 Feb 7.

Authors

Benjamin Djulbegovic¹, Ambuj Kumar², Richard M Kaufman³, Aaron Tobian⁴, Gordon H Guyatt⁵

Affiliations

¹ Division of Evidence Based Medicine, Department of Internal Medicine, USF Health Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Moffitt Cancer Center and Tampa General Hospital, Tampa, FL, USA. Electronic address: bdjulbeg@health.usf.edu.
² Division of Evidence Based Medicine, Department of Internal Medicine, USF Health Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Moffitt Cancer Center and Tampa General Hospital, Tampa, FL, USA.
³ Department of Pathology, Brigham and Women's Hospital, Amory 260, 75 Francis Street, Boston, MA 02115, USA.
⁴ Department of Pathology, John Hopkins Hospital, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
⁵ Department of Clinical Epidemiology & Biostatistics; Department of Medicine, McMaster University, 1280 Main Street West, Rm. 2C12 Hamilton, Ontario, Canada L8S 4K1.

PMID: 25766057
DOI: 10.1016/j.jclinepi.2014.12.015

Abstract

Objectives: The objective of the study was to assess the association between Grading of Recommendations Assessment, Development and Evaluation (GRADE) factors and the strength of recommendations.

Study design and setting: The study was conducted as part of the development of clinical practice guideline (CPG) by American Association of Blood Banking related to role of prophylactic vs. therapeutic transfusion for the management of thrombocytopenia. The association between GRADE factors and strength of recommendations was assessed using logistic regression and multilevel mixed effect logistic regression model.

Results: Seventeen members of the CPG panel participated in the recommendation process. The quality of evidence was the only statistically significant (odds ratio = 4.5; P < 0.001) GRADE factor associated with the strength of recommendations. The predictive model showed that there is about 90% probability that panelists would issue the same (strong) recommendation when confidence in the effects of intervention is high vs. 10% when the quality of evidence is very low.

Conclusion: The results showed that quality of evidence is a key determinant for making a strong vs. a weak recommendation.

Keywords: Evidence-based medicine; Guideline development; Practice guidelines; Practice recommendations; Quality of evidence; quality improvement; trustworthy guidelines.

MeSH terms

Blood Banks / organization & administration*
Blood Banks / standards*
Evidence-Based Medicine / methods*
Evidence-Based Medicine / standards
Health Planning Guidelines*
Humans
Logistic Models
Practice Guidelines as Topic
Program Development
Quality Improvement / organization & administration*
Thrombocytopenia / prevention & control
Thrombocytopenia / therapy*
United States