Article Text

Making GRADE accessible: a proposal for graphic display of evidence quality assessments
  1. Khalid S Khan1,
  2. Ewa Borowiack2,
  3. Carolien Roos3,
  4. Monika Kowalska2,
  5. Anna Zapalska2,
  6. Ben W Mol4,
  7. Luciano Mignini5,
  8. Catherine Meads1,
  9. Jacek Walczak2,
  10. for the EBM-CONNECT Collaboration
  1. 1Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Arcana Institute, Cracow, Poland
  3. 3Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. 4Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  5. 5Centro Rosarino de Estudios Perinatales, Rosario, Argentina
  1. Correspondence to Professor Khalid Khan
    Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK; k.s.khan{at}

Statistics from

When generating guidelines, quality of evidence is frequently reported in tabulated form capturing several domains, for example, study design, risk of bias and heterogeneity. Increasingly, this is done using the Grading of Recommendations Assessment, Development and Evaluation approach. As assimilating large amount of tabulated data across several comparisons and outcomes spread over many pages (sometimes hundreds) is not easy, there is a need to present evidence summaries in a more effective way. A graphic display plotting the several domains used in evidence grading on equiangular spokes starting from the same point, the data length of each spoke proportional to the magnitude of the quality, succinctly captures tabulated information. These plots allow easy identification of deficiencies, outliers and similarities in evidence quality for individual and multiple comparisons and outcomes, paving the way for their routine use alongside tabulated information.


Improving healthcare through evidence-based practice and policy hinges on decision-making informed by summarised research findings. Deciphering the salience of findings is not straightforward particularly when there are many competing interventions whose effects are evaluated on several outcomes ranging from critical to unimportant and when the strength of the evidence may vary for each. For generating recommendations, the quality …

View Full Text

Supplementary materials

  • Web Only Data ebm0005

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.