GRADE: A Transparent Approach for Evidence-Based Recommendations and Decisions in Health

Trustworthy evidence syntheses using systematic review methodology are essential to make trustworthy decisions. To assess the certainty of a body of evidence included in a systematic review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group has developed an approach that is used by over 110 organizations, including the World Health Organization and the Cochrane Collaboration. GRADE provides operational definitions and instructions to rate the certainty of the evidence for each outcome in a review as high, moderate, low, or very low for the effects of interventions, prognostic estimates, values and preferences, test accuracy, resource utilization and other health questions. The assessment includes assessing the possible impact of risk of bias, imprecision, inconsistency, indirectness, and publication bias, the magnitude of effects, dose-response relations and residual plausible bias on effects or associations. Summary statistical information and assessments of certainty are presented in GRADE evidence summary tables, which are supported by GRADE’s official GRADEpro software tool. The evidence summary tables feed into the GRADE Evidence to Decision frameworks which allow creating bridges across health decision-making disciplines and support transparency and trust when making recommendations and informing health policy.