GRADE-Leitlinien: 9. Heraufstufen der Qualität der Evidenz Academic Article uri icon

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  • The most common reason for rating up the quality of evidence is a large effect. GRADE suggests considering rating up quality of evidence one level when methodologically rigorous observational studies show at least a two-fold reduction or increase in risk, and rating up two levels for at least a five-fold reduction or increase in risk. Systematic review authors and guideline developers may also consider rating up quality of evidence when a dose-response gradient is present, and when all plausible confounders or biases would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect. Other considerations include the rapidity of the response, the underlying trajectory of the condition and indirect evidence.


  • Kien, Christina
  • Gartlehner, Gerald
  • Kaminski-Hartenthaler, Angela
  • Meerpohl, Joerg J
  • Flamm, Maria
  • Langer, Gero
  • Perleth, Matthias
  • Schunemann, Holger

publication date

  • 2013