New GRADE Evidence-to-Decision Framework for Pairwise and Multiple Comparisons (GRADE Guidance 45)

This article describes the new EtD framework, which now includes 2 corresponding parts for reviews of pairwise and multiple comparisons. The authors describe application to a review with multiple comparisons for the different parts of the EtD framework: the question definition, which now includes the presentation of values of health outcomes and decision thresholds; the assessment section, where the new "net effect" criterion has been included; and the conclusion section, which includes an adaptation for multiple comparisons. The article provides examples and suggestions for presentation of findings. The framework does have limitations, in that its usability has not been tested across a broad spectrum of guideline development contexts.

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Publication Details

Journal
Annals of Internal Medicine
Published
2026-03-16
DOI
https://doi.org/10.7326/annals-25-04273
Primary Topic
Meta-analysis and systematic reviews
Type
article
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article

New GRADE Evidence-to-Decision Framework for Pairwise and Multiple Comparisons (GRADE Guidance 45)

Nancy Santesso, Glen Hazlewood, C. Canelo-Aybar, Bart Dietl et al.
Annals of Internal Medicine
Meta-analysis and systematic reviews
article

New GRADE Evidence-to-Decision Framework for Pairwise and Multiple Comparisons (GRADE Guidance 45)

Nancy Santesso, Glen Hazlewood, C. Canelo-Aybar, Bart Dietl, Hans de Beer, Martin Mayer, Tatyana Shamliyan, Reem A. Mustafa, Thomas Piggott, Holger J. Schünemann, Jessica Beltrán, Wojtek Wiercioch, Pablo Alonso-Coello, Alonso Carrasco-Labra, Itziar Etxeandia-Ikobaltzeta, Gordon Guyatt, Francesco Nonino, Alexander G. Mathioudakis, Romina Brignardello-Petersen, Elie A. Akl
article en

Abstract

This article describes the new EtD framework, which now includes 2 corresponding parts for reviews of pairwise and multiple comparisons. The authors describe application to a review with multiple comparisons for the different parts of the EtD framework: the question definition, which now includes the presentation of values of health outcomes and decision thresholds; the assessment section, where the new "net effect" criterion has been included; and the conclusion section, which includes an adaptation for multiple comparisons. The article provides examples and suggestions for presentation of findings. The framework does have limitations, in that its usability has not been tested across a broad spectrum of guideline development contexts.

Annals of Internal Medicine
Cone Health (US), Humanitas University (IT), Manchester Academic Health Science Centre (GB), American College of Physicians (US), Hamilton Regional Laboratory Medicine Program (CA), Alberta Bone and Joint Health Institute (CA), Istituto delle Scienze Neurologiche di Bologna (IT), University of Kansas Medical Center (US), Iberoamerican Cochrane Centre (ES), IRCCS Humanitas Research Hospital (IT), Child Guidance Center (US), University of Pennsylvania (US), McMaster University (CA), American University of Beirut (LB)
Peace, Justice and strong institutions
Openalex Percentile: Top 23%
Meta-analysis and systematic reviews
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