Article type
Abstract
Background: The GRADE system constitutes a comprehensive and transparent framework for the assessment of certainty of evidence (CoE) and the formulation of recommendations. Since the publication of the initial version of the Brazilian GRADE manual in 2014, significant updates occurred in the method that has yet to be modified in the manual.
Aim: To describe the updating process of GRADE guidelines to conduct an evidence synthesis process to support decision-making in Brazilian public health services.
Methods: First, the scope and contents of the new GRADE guidelines for evidence synthesis and recommendation development were defined. Researchers conducted literature searches in Cochrane’s GRADE handbook, GRADE series of concepts and guidelines published in scientific journals to create a new version of the manual. The authors from the first version of the manual were involved in the construction of the update through the revision process.
Results: The second edition of the Brazilian guideline on GRADE method was updated to address the following topics: a) evidence-based health; b) research question and outcome selection; c) CoE assessment; d) evidence synthesis; e) GRADE for health recommendations; f) GRADE for test accuracy; g) GRADE for prognosis, incidence and prevalence; h) GRADE for network meta-analysis; i) GRADE for modeling; j) GRADE for health technology assessment; k) GRADE for public health; l) GRADE for urgency and emergency situations. After the initial draft of the document, a panel composed by 13 experts evaluated the guideline and provided their recommendations on structure, scope, and possible additional points of inclusion. Finally, the public consultant included new considerations during the external review process. Some advances were, but not limited to, the inclusion of new risk of bias tools and updates in inconsistency and imprecision assessment, evidence to the decision process, and CoE assessment of network meta-analysis.
Conclusions: Main progress has likely occurred in the development of clinical guidelines, with the GRADE system being employed not only in assessing CoE but also in the formulation of recommendations. The GRADE system has progressed to encompass the evaluation of health interventions, diagnostic tests, incidence estimates, prevalence, prognosis, indirect comparisons, and modeling.
Aim: To describe the updating process of GRADE guidelines to conduct an evidence synthesis process to support decision-making in Brazilian public health services.
Methods: First, the scope and contents of the new GRADE guidelines for evidence synthesis and recommendation development were defined. Researchers conducted literature searches in Cochrane’s GRADE handbook, GRADE series of concepts and guidelines published in scientific journals to create a new version of the manual. The authors from the first version of the manual were involved in the construction of the update through the revision process.
Results: The second edition of the Brazilian guideline on GRADE method was updated to address the following topics: a) evidence-based health; b) research question and outcome selection; c) CoE assessment; d) evidence synthesis; e) GRADE for health recommendations; f) GRADE for test accuracy; g) GRADE for prognosis, incidence and prevalence; h) GRADE for network meta-analysis; i) GRADE for modeling; j) GRADE for health technology assessment; k) GRADE for public health; l) GRADE for urgency and emergency situations. After the initial draft of the document, a panel composed by 13 experts evaluated the guideline and provided their recommendations on structure, scope, and possible additional points of inclusion. Finally, the public consultant included new considerations during the external review process. Some advances were, but not limited to, the inclusion of new risk of bias tools and updates in inconsistency and imprecision assessment, evidence to the decision process, and CoE assessment of network meta-analysis.
Conclusions: Main progress has likely occurred in the development of clinical guidelines, with the GRADE system being employed not only in assessing CoE but also in the formulation of recommendations. The GRADE system has progressed to encompass the evaluation of health interventions, diagnostic tests, incidence estimates, prevalence, prognosis, indirect comparisons, and modeling.