Journal Article

GRADE guidelines: 21 part 1. Study design, risk of bias, and indirectness in rating the certainty across a body of evidence for test accuracy

Hultcrantz, Monica, Mustafa, Reem A., Helfand, Mark, Santesso, Nancy, Ansari, Mohammed T., Rosen, Måns, Meerpohl, Joerg, Crowther, Mark, Schünemann, Holger J., Leeflang, Mariska, Scholten, Rob, Kunz, Regina, Muti, Paola, Hooft, Lotty, Langendam, Miranda, Raatz, Heike, Harris, Jeff, Glasziou, Paul, Lange, Stefan, Bossuyt, Patrick, Brozek, Jan, Williams, John, Akl, Elie A., Steingart, Karen R., Guyatt, Gordon H., Jaeschke, Roman, Rodriguez, Ingrid Arévalo, Rutjes, Anne, Vist, Gunn E., Kohli, Mikashmi, Murad, Mohammad Hassan

2020

Overview

This article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments and guideline developers can assess the results and the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA). We present an overview of the GRADE approach and guidance for rating certainty in TA in clinical and public health and review the presentation of results of a body of evidence regarding tests. Part 1 of the two parts in this 21st guidance article about how to apply GRADE focuses on understanding study design issues in test accuracy, provide an overview of the domains, and describe risk of bias and indirectness specifically. Supplemented by practical examples, we describe how raters of the evidence using GRADE can evaluate study designs focusing on tests and how they apply the GRADE domains risk of bias and indirectness to a body of evidence of TA studies. Rating the certainty of a body of evidence using GRADE in Cochrane and other reviews and World Health Organization and other guidelines dealing with in TA studies helped refining our approach. The resulting guidance will help applying GRADE successfully for questions and recommendations focusing on tests.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Accuracy / Bias / Biomedical Research - standards / Certainty of evidence / Data Accuracy / Design / Diagnosis / Diagnostic accuracy / Domains / Epidemiology / GRADE / GRADE Approach - standards / Guidelines / Guidelines as Topic / HIV / Human immunodeficiency virus / Human papillomavirus / Humans / Internal Medicine / Literature reviews / Medical diagnosis / Patients / Population / Public health / Publication Bias - statistics & numerical data / Quality / Research Design - standards / Risk / Technology assessment / Test accuracy / Tests