As many as one-third of guideline-producing health organizations in the United States report using the GRADE framework, but exactly how closely these organizations follow the key tenets of GRADE - such as using evidence summaries of each identified outcome to inform the overall certainty of evidence, and linking this certainty to a strength of recommendation - is a matter of debate.
In study by Dixon and colleagues published earlier this year in the Journal of Clinical Epidemiology, the authors set out to evaluate the use of GRADE in U.S.-based guidelines published between 2011 and 2018 and available in the National Guidelines Clearinghouse. Assessing up to three of the most recent guidelines from each of 135 identified U.S.-based organizations, the authors used several criteria to examine how closely each of the 67 resulting guidelines adhered to core GRADE concepts, including:
- defining the certainty of evidence,
- explicitly considering the GRADE domains when assessing the certainty of evidence, and
- consistently defining the strength of resulting recommendations as strong or weak/conditional.
|Figure from Dixon et al. shows the relative reporting frequency of the various GRADE criteria for assessing certainty of evidence in years 2011-14 versus 2015-18, suggesting a trend for improved reporting over time. Click to enlarge.