A systematic review of grading systems for recommendations about medical tests

Abstract text
There is growing awareness that evidence-based guideline recommendations need to take into account patient outcomes. This poses challenges for recommendations about medical tests, where such direct evidence often does not exist. Using and linking different types of indirect evidence is still under development and grading systems may address this differently. We compared grading systems for recommendations about medical tests in terms of basic guideline quality requirements and on how they appraise and link indirect evidence.

We searched various information platforms for grading systems that explicitly stated they could be used for medical tests. Basic guideline quality requirements as defined in the AGREE instrument 2003 were used to define two sets of assessment categories: process and methodological characteristics. Two reviewers independently extracted the data. Differences were resolved through discussion.

Twelve grading systems could be included, all differing in the extent to which they addressed process and methodological characteristics. Process characteristics most often addressed were the need for a representative guideline panel (8/12) and providence of guidance on dissemination and communication (7/12). Characteristics least often addressed were information on whether the system was piloted before finalization (3/12) and on the need to be explicit about funder information (3/12). For methodological characteristics, developing a clinical scenario and/or analytical framework, having explicit criteria for appraising and linking indirect evidence, and having explicit methodologies for translating such evidence into recommendations were least likely to be addressed. Only three systems at most addressed each of these, in variable ways, and to varying degrees of explicitness and completeness.

Grading systems for medical tests vary in basic guideline quality requirements. Majority of them do not address the use of indirect evidence. For those that did, methodologies for linking such evidence were varied and not always explicit.
Gopalakrishna G1, Langendam M2, Scholten R2, Leeflang M1, Bossuyt P1
1 Academic Medical Centre, University of Amsterdam, The Netherlands
2 Dutch Cochrane Centre, The Netherlands
Presenting author and contact person
Presenting author: 
Gowri Gopalakrishna
Contact person Affiliation Country
Gowri Gopalakrishna (Contact this person) Academic Medical Centre University of Amsterdam Netherlands
Date and Location
Oral session B6O1
Tuesday 2 October 2012 - 11:00 - 11:20