Healthcare Recommendations: Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Approach

This chapter investigates the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to guideline recommendation development. A GRADE assessment is conducted on a body of literature that was collated through a systematic review. The GRADE framework provides guidance on how the working group should proceed to develop clinical recommendation on hemiarthroplasty or total hip arthroplasty use for displaced femoral neck fractures. The GRADE approach to assessing quality of evidence takes the following concepts into consideration: the study design of the available evidence, risk of bias, imprecision, inconsistency, indirectness, and publication bias. Well‐done observational studies will include adjusted analyses that incorporate all important factors that may be confounders. The strength of a guideline recommendation may be reduced if there are strong preferences from relevant stakeholders that would be pertinent to the clinical decision‐making process. The GRADE approach results in a transparent clinical recommendation with a corresponding strength associated with the certainty of the guideline panel.