Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable

Gowri Gopalakrishna*, Reem A. Mustafa, Clare Davenport, Rob J.P.M. Scholten, Christopher Hyde, Jan Brozek, Holger J. Schünemann, Patrick M.M. Bossuyt, Mariska M.G. Leeflang, Miranda W. Langendam

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group developed an approach to assess the quality of evidence of diagnostic tests. Its use in Cochrane diagnostic test accuracy reviews is new. We applied this approach to three Cochrane reviews with the aim of better understanding the application of the GRADE criteria to such reviews. Study Design and Setting We selected reviews to achieve clinical and methodological diversities. At least three assessors independently assessed each review according to the GRADE criteria of risk of bias, indirectness, imprecision, inconsistency, and publication bias. Two teleconferences were held to share experiences. Results For the interpretation of the GRADE criteria, it made a difference whether assessors looked at the evidence from a patient-important outcome perspective or from a test accuracy standpoint. GRADE criteria such as inconsistency, imprecision, and publication bias were challenging to apply as was the assessment of comparative test accuracy reviews. Conclusion The perspective from which evidence is graded can influence judgments about quality. Guidance on application of GRADE to comparative test reviews and on the GRADE criteria of inconsistency, imprecision, and publication bias will facilitate the operationalization of GRADE for diagnostics.

Original languageEnglish
Pages (from-to)760-768
Number of pages9
JournalJournal of Clinical Epidemiology
Issue number7
Publication statusPublished - Jul 2014

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