Objective:
To learn how to apply the GRADE approach to assessing the quality of evidence and preparing a summary of findings table for diagnostic tests
Summary:
Many organizations apply the GRADE approach to grading the quality of evidence and strength of recommendations for interventions. Cochrane review authors use the GRADE approach to grade the quality of evidence for interventions studies in Cochrane summary of findings (SoF) tables - a presentation of the most important information and findings of a review in a table format. The GRADE working group has suggested a separate approach to grading the quality of evidence for questions of diagnostic accuracy. Using this approach, cross sectional or cohort studies can provide high quality evidence of test accuracy if they are linked to direct information about patient-important outcomes. However, test accuracy is a surrogate for patient-important outcomes, so that these studies often provide low quality evidence for recommendations about diagnostic tests, even when the studies do not have serious limitations. This is due to the recognition that inference from data on accuracy of a diagnostic test or strategy requires information whether applying the test improves patient-important outcomes (i.e. because of availability of effective treatment, reduction of test related adverse effects or anxiety, or improvement of patients' wellbeing from prognostic information). Therefore, studies that provide high quality information about accuracy may provide only low quality evidence of impact on patient-important outcomes, and thus low quality evidence for recommendations about diagnostic test use. Judgments are thus needed to assess the directness of test results in relation to consequences on patient-important outcomes. This workshop will introduce this approach based on examples and hands-on exercises.