Core GRADE 2: choosing the target of certainty rating and assessing imprecision
This second article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to deciding on the target of the certainty rating, and decisions about rating down certainty of evidence due to imprecision. Core GRADE users assess if the true underlying treatment effect is important or not in relation to the minimal important difference (MID) or, alternatively, if a true underlying treatment effect exists. The location of the point estimate of effect in relation to the chosen threshold determines the target. For instance, using the MID thresholds, a point estimate greater than the MID suggests an important effect and less than the MID, an unimportant or little to no effect. Users then rate down for imprecision if the 95% confidence interval crosses the MID for benefit or harm.
Authors
- Arnav Agarwal (ORCID: https://orcid.org/0000-0001-5780-725X)
- Romina Brignardello‐Petersen (ORCID: https://orcid.org/0000-0002-6010-9900)
- Thomas Agoritsas (ORCID: https://orcid.org/0000-0002-6182-9969)
- Manya Prasad (ORCID: https://orcid.org/0000-0002-1239-0013)
- Per Olav Vandvik (ORCID: https://orcid.org/0000-0001-8958-2710)
- Gordon Guyatt (ORCID: https://orcid.org/0000-0003-2352-5718)
- Monica Hultcrantz (ORCID: https://orcid.org/0000-0002-5140-4289)
- Alfonso Iorio (ORCID: https://orcid.org/0000-0002-3331-8766)
- Hans de Beer
- Jamie Rylance (ORCID: https://orcid.org/0000-0002-2323-3611)
- Chunjuan Zhai (ORCID: https://orcid.org/0000-0002-2953-7907)
- M. Hassan Murad (ORCID: https://orcid.org/0000-0001-5502-5975)
- Linan Zeng (ORCID: https://orcid.org/0000-0001-9892-2000)
- Reem A. Mustafa (ORCID: https://orcid.org/0000-0002-2091-0875)
- Liang Yao (ORCID: https://orcid.org/0000-0003-4068-3136)
- Víctor M. Montori (ORCID: https://orcid.org/0000-0003-0595-2898)
- Lingli Zhang (ORCID: https://orcid.org/0009-0003-4934-8374)
- Prashanti Eachempati
Institutions
- Mayo Clinic (US)
- Nanyang Technological University (SG)
- University of Oslo (NO)
- Liverpool School of Tropical Medicine (GB)
- Sichuan University (CN)
- West China Medical Center of Sichuan University (CN)
- Karolinska Institutet (SE)
- West China Second University Hospital of Sichuan University (CN)
- China First Heavy Industries (China) (CN)
- University Hospital of Geneva (CH)
- Shandong Provincial Hospital (CN)
- Manipal University College Malaysia (MY)
- Institute of Liver and Biliary Sciences (IN)
- Mayo Clinic in Arizona (US)
- University of Kansas Medical Center (US)
- Stockholm Health Care Services (SE)
- Mayo Clinic in Florida (US)
- Impact (CA)
- Shandong First Medical University (CN)
- Child Guidance Center (US)
- Geneva College (US)
- University of Plymouth (GB)
- McMaster University (CA)
Publication Details
- Journal
- BMJ
- Published
- 2025-04-29
- DOI
- https://doi.org/10.1136/bmj-2024-081904
- Citations
- 29
- Primary Topic
- Sepsis Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 39.27