Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive

Jaeschke, Roman; Guyatt, Gordon; Dellinger, Phil; Schünemann, Holger J.; Levy, Mitchell M.; Kunz, Regina; Norris, Susan L.; Bion, Julian

doi:10.1136/bmj.a744

Cited by 501 publications

(306 citation statements)

References 14 publications

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“…[2][3][4][5][6][7][8][9][10][11] With use of their focused literature lists, section authors were asked to create recommendations for their assigned topic. Best evidence studies were short listed to identify quality of evidence ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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Section: Methodsmentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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“…Consensus was defined as 75% or more of the members of the TEP voting to either strongly or conditionally recommend using a modality, either strongly or conditionally recommend not using a modality, or choosing not to make a recommendation on the use of a modality (23). A strong recommendation for using a modality required high-quality evidence and evidence of a large gradient of difference between desirable and undesirable effects of the treatment (i.e., benefits compared to harms).…”

Section: Recommendation Developmentmentioning

confidence: 99%

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee

Hochberg

Altman

April

et al. 2012

Arthritis Care & Research

2,538

1,840

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Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) Results. Both "strong" and "conditional" recommendations were made for OA management. Modalities conditionally recommended for the management of hand OA include instruction in joint protection techniques, provision of assistive devices, use of thermal modalities and trapeziometacarpal joint splints, and use of oral and topical nonsteroidal antiinflammatory drugs (NSAIDs), tramadol, and topical capsaicin. Nonpharmacologic modalities strongly recommended for the management of knee OA were aerobic, aquatic, and/or resistance exercises as well as weight loss for overweight patients. Nonpharmacologic modalities conditionally recommended for knee OA included medial wedge insoles for valgus knee OA, subtalar strapped lateral insoles for varus knee OA, medially directed patellar taping, manual therapy, walking aids, thermal agents, tai chi, selfmanagement programs, and psychosocial interventions. Pharmacologic modalities conditionally recommended for the initial management of patients with knee OA included acetaminophen, oral and topical NSAIDs, tramadol, and intraarticular corticosteroid injections; intraarticular hyaluronate injections, duloxetine, and opioids were conditionally recommended in patients who had an inadequate response to initial therapy. Opioid analgesics were strongly recommended in patients who were either not willing to undergo or had contraindications for total joint arthroplasty after having failed medical therapy. Recommendations for hip OA were similar to those for the management of knee OA. Conclusion. These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines, informed by available evidence, balancing the benefits and harms of both nonpharmacologic and pharmacologic modalities, and incorporating their preferences and values. It is hoped that these recommendations will be utilized by health care providers involved in the management of patients with OA.

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“…In concordance with the levels of agreement appropriate for consensus [48], all expert consensus definitions for which more than 80% of the members voted to accept "as is" were retained, while all with less than 50% acceptance were rejected. Definitions with only 50-80% agreement were revised through ongoing discussions until complete consensus was obtained.…”

Section: Evaluation Of Existing Expert Consensus Definitionsmentioning

confidence: 95%

Methodological background and strategy for the 2012−2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society

Kirkpatrick¹,

Roberts²,

Jaeschke³

et al. 2015

Anaesthesiol Intensive Ther

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The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH/ /ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format. Scientific consultations were obtained from Methodological GRADE experts and a series of educational teleconferences were conducted to educate scientific review teams from among the wscacs. org membership. Each team conducted systematic or structured reviews to identify relevant studies and prepared evidence summaries and draft Grades of Recommendation Assessment, Development and Evaluation (GRADE) recommendations. The evidence and draft recommendations were presented and debated in person over four days. Updated consensus definitions and management statements were derived using a modified Delphi method. A writing

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Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive

Abstract: The large and diverse nature of guideline committees can make consensus difficult. Roman Jaeschke and colleagues describe a simple technique for clarifying opinion

Cited by 501 publications

References 14 publications

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee

Methodological background and strategy for the 2012−2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society

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