EBM NOTEBOOK

GRADE: assessing the quality of evidence for diagnostic recommendations

Holger J Schünemann¹, Andrew D Oxman², Jan Brozek³, Paul Glasziou⁴, Patrick Bossuyt⁵, Stephanie Chang⁶, Paola Muti³, Roman Jaeschke¹, Gordon H Guyatt¹

¹ McMaster University, Hamilton, Ontario, Canada
² Norwegian Knowledge Centre for the Health Services, Oslo, Norway
³ Italian National Cancer Institute Regina Elena, Rome, Italy
⁴ University of Oxford, Oxford, UK
⁵ University of Amsterdam, Amsterdam, Netherlands
⁶ Agency for Healthcare Research and Quality, Rockville, Maryland, USA

The first 150 words of the full text of this article appear below.

Making a diagnosis is the bread and butter of clinical practice, but in today’s world of many tests, the process has become complex. Guidelines for making an evidence-based diagnosis abound, but those making recommendations about diagnostic tests or test strategies must realise that clinicians require support to make diagnostic decisions that they can easily implement in daily practice. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group has developed a rigorous, transparent, and increasingly adopted approach for grading the quality of research evidence and strength of recommendations to guide clinical practice. This Notebook summarises GRADE’s process for developing recommendations for tests.¹

Clinicians are trained to use tests for screening and diagnosis, identifying physiological derangements, establishing a prognosis, and monitoring illness and treatment response by assessing signs and symptoms, imaging, biochemistry, pathology, and psychological testing techniques.² Sensitivity, specificity, positive predictive value, likelihood ratios, and diagnostic odds ratios are among . . . [Full text of this article]

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