GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)

Guyatt, Gordon; Oxman, Andrew D; Vist, Gunn Elisabeth; Kunz, Regina; Brožek, Jan; Alonso‐Coello, Pablo; Montori, Víctor M.; Akl, Elie A.; Djulbegovic, B.; Falck‐Ytter, Yngve; Norris, Susan L.; Williams, John W; Atkins, David C.; Meerpohl, Joerg J; Schünemann, Holger J.

doi:10.1016/j.jclinepi.2010.07.017

Cited by 2,298 publications

(1,608 citation statements)

References 38 publications

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“…17 to 93) ( Table 2). The quality of evidence was downgraded to moderate, because of variability across studies and some methodological heterogeneity41. Two subgroup analyses were conducted.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

172

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BackgroundPostoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.MethodsThis was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.ResultsTen studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.ConclusionCompared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.

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Section: Resultsmentioning

confidence: 99%

“…The same research group designed and conducted all three studies on seroma, and the studies were methodologically homogeneous. The quality of evidence was downgraded to moderate because of missing methodological information resulting in moderate risk of bias, and because of the few studies, with small sample sizes41, 44.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

172

View full text Add to dashboard Cite

show abstract

“…Thus, identifying possible biases in the conducted trials are essential [24]. The included trials in the present review had some shortcomings: First, the trials varied considerably in terms of sample size.…”

Section: Methodsological Quality Of the Included Trialsmentioning

confidence: 99%

“…The assessment was based on the criteria for "risk of bias" within the GRADE system for rating quality of evidence [24]. These criteria are: randomisation procedures, allocation concealment, blinding, power-estimation, loss to follow-up, intention-to-treat analysis and selective end-point reporting.…”

Section: Assessment Of Study Limitationsmentioning

confidence: 99%

Effect of physical exercise on muscle mass and strength in cancer patients during treatment—A systematic review

Stene¹,

Helbostad²,

Balstad³

et al. 2013

Critical Reviews in Oncology/Hematology

176

105

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“…The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principles are applied to determine whether evidence in the literature was sufficient to place a given variant in a category based on actionability. [20][21][22][23][24][25] Briefly, randomized controlled trials (e.g., phase III studies) are considered to be high-quality evidence, whereas observational and non-human studies are considered low-quality evidence, with adjustments to level of evidence based on number and consistency of studies, magnitude of effect reported, known or potential study bias and limitations, and potential publication bias.…”

Section: Assessment Protocol For Svcmentioning

confidence: 99%