Adherence of the European Association of Urology Guidelines to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Methodology

Dahm, Philipp; Cleveland, Brent; Lauwagie, Andrew; González-Padilla, D.A.

doi:10.1016/j.eururo.2023.02.023

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…In urology, it is being used by guidelines developed by the AUA as the system for rating the certainty of evidence (whereas the organization has developed its own approach for developing and categorizing recommendations) 4 and the European Association of Urology, which employs GRADE mainly for framing its recommendations (as strong or weak) while relying on a modified Oxford Center for Evidence-based Medicine hierarchy of evidence approach in rating the evidence. 5 GRADE is mandatory for urological Cochrane reviews, and is also being increasingly used by authors of SRs published in urological journals. This uptake of GRADE is a positive development, reflecting a trend toward its use as a unified system or lingua franca to serve as a common platform to permit sharing of evidence reports and enhanced collaboration while avoiding unnecessary duplication of efforts.…”

Section: Figurementioning

confidence: 99%

GRADE Reporting in Systematic Reviews Published in the Urological Literature (2009-2021)

et al. 2023

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Purpose:We evaluate the reporting of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rating the certainty of evidence in systematic reviews published in the urological literature.Materials and Methods:Based on a predefined protocol, we identified all systematic reviews published in 5 major urological journals from 1998 to 2021 that reported the use of GRADE. Two authors performed study selection and data abstraction independently to assess reporting in accordance with established criteria for applying GRADE.Results:We included 68 of 522 (13.0%) systematic reviews that reported the use of GRADE; the first was published in 2009. Approximately half were published between 2009-2018 (n=36) and the other half between 2019-2021 (n=32). Oncology (24; 35.3%) was the most common clinical topic, and the authors were mostly based in Europe (34; 50%). In their abstract, less than half of all systematic reviews (32; 47.1%) provided any certainty of evidence rating. Only 41 (60.3%) included a tabular result summary in the format of a summary of findings table (24; 35.3%) or evidence profile (17; 25.0%). Few (35.3%) addressed the GRADE certainty of evidence rating in the discussion section. Reporting did not improve over time when comparing the 2 time periods.Conclusions:Whereas GRADE is increasingly being applied for rating the certainty of evidence, systematic reviews published in the urological literature frequently have not followed established criteria for applying or using GRADE. There is a need for better training of authors and editors, as well as for a GRADE reporting checklist for systematic review authors.

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Section: Figurementioning

confidence: 99%

GRADE Reporting in Systematic Reviews Published in the Urological Literature (2009-2021)

et al. 2023

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“…Among the urology-relevant guidelines, GRADE is used to rate the CoE in the American Urological Association guidelines with the modification that the ''low'' and ''very low'' categories have been collapsed. GRADE is also used in selected European Association of Urology [4,5] and Canadian Urological Association [6] guidelines. In the following, we describe the GRADE process for assessing the CoE, as depicted in Figure 1.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Certainty of Evidence in Evidence-based Medicine

González-Padilla,

Dahm

2023

European Urology Focus

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Analysis of European Association of Urology Guidelines 2023 and its adherence to GRADE methodology

Dahm,

Holten,

Ratanawong

et al. 2024

Clinical and Public Health Guidelines

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IntroductionThe European Association of Urology (EAU) has reported the use of a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for developing guideline recommendations since 2018; however, the full adoption of GRADE remains a work in progress.MethodsTwo members of the research team identified and independently abstracted all individual recommendations and summary of evidence statements available from all EAU guidelines published in 2023. We evaluated the current adherence to established criteria for appropriate GRADE use, the proportion of strong and weak recommendations, the underlying strength of evidence, and criteria for appropriate use of GRADE.ResultsWe included a total of 20 guideline documents with a total number of 1985 recommendations. The median number of strong recommendations was 46 (interquartile range: 32–87), representing 62.6% of all recommendations. The surgical thromboprophylaxis guideline had the lowest percentage of strong recommendations (18.2%; 30/165), and the neuro‐urology guideline had the highest percentage (95.5%; 42/44). EAU guidelines provided 2580 summaries of evidence statements, of which 1608 reported a level of evidence. The reported levels of evidence were I, II, III and IV/V at 31.8%, 28.5%, 32.4% and 7.3%, respectively. Of the six criteria for the appropriate use of GRADE, criterion 6, which reports the framing of recommendations as strong or weak, was met consistently; all other criteria were met only by a single guideline on thromboprophylaxis.ConclusionsThe EAU guidelines adoption of GRADE has been largely limited to the framing of recommendations as strong or weak. In all but one guideline, published guidelines did not meet any of the other criteria for appropriate GRADE use. Increased efforts to fully adopt GRADE, similar to its implementation in the thromboprophylaxis guideline in future editions, may enhance trust and uptake of EAU guidelines, thereby assisting policymakers and improving patient care.

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Adherence of the European Association of Urology Guidelines to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Methodology

Cited by 5 publications

References 4 publications

GRADE Reporting in Systematic Reviews Published in the Urological Literature (2009-2021)

GRADE Reporting in Systematic Reviews Published in the Urological Literature (2009-2021)

Evaluating the Certainty of Evidence in Evidence-based Medicine

Analysis of European Association of Urology Guidelines 2023 and its adherence to GRADE methodology

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