Guidelines: Rating the quality of evidence and grading the strength of recommendations

Abstract

Clinical experts and organizations providing recommendations in the form of clinical practice guidelines have to carefully consider the quality of the available evidence. Grading the strength of recommendations, if performed on the basis of a rigorous methodology, can improve communication of best practices and reduce errors. The GRADE system provides criteria for decisions regarding both quality of evidence and the balance of desirable and undesirable consequences of alternative management strategies. Such a universal, methodologically sound, and widely accepted methodology to support guideline development could help to lay the framework for international collaboration and to effectively use limited resources.