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Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to rate the certainty of evidence of study outcomes from systematic reviews: A quick tutorial
Shih-Chieh Shao1, Liang-Tseng Kuo2, Yen-Ta Huang3, Pei-Chun Lai4, Ching-Chi Chi5
1 Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan
2 School of Medicine, College of Medicine, Chang Gung University, Taoyuan; Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
3 Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
4 Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
5 School of Medicine, College of Medicine, Chang Gung University; Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
Correspondence Address:
Prof. Ching-Chi Chi
Department of Dermatology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan District, Taoyuan
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ds.DS-D-22-00154
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The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework offers a structured approach to assess the certainty of evidence (CoE) in systematic reviews (SRs). The CoE for each outcome falls into one of the four categories: very low, low, moderate, or high. The judgment of CoE is based on five downgrading factors (including the risk of bias, indirectness, inconsistency, imprecision, and publication bias) and three upgrading factors (including large effect size, dose-response relationship, and opposing plausible residual bias and confounding). To improve the transparency of SRs, authors should indicate how they grade the CoE for each outcome and provide a rationale for downgrading or upgrading the CoE.
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