GRADE notes: How to use GRADE when there is “no” evidence? A case study of the expert evidence approach
Abstract
Objectives
One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not exist. In this brief report (GRADE notes), we describe our method of developing evidence-based recommendations when publisheddirect evidence was lacking.
Study Design and Setting
When direct published literature was absent, an expert evidence survey was administered to panel members about their unpublished observations and case series. Focus was on collecting data about cases and outcome, not panel opinions.
Results
Out of 26 questions prioritized by the panel for pediatric venous thromboembolism, 12 had no, very limited, or very low certainty of evidence to inform them. The panel survey was administered for these questions.
Conclusions
Areas of sparse evidence often reflect key questions that are critical to address in clinical practice guidelines due to the uncertainty among health care providers. The expert evidence approach used in this study is one method for panels totransparently deal with the lack of published evidence to directly inform recommendations.
What is new?
Key findings
- •
Guideline developers can apply GRADE and use a structured approach of summarizing collective expert experience when published evidence is limited or non-existing
What this adds to what is known
- •
The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, guidance about developing evidence-based recommendations when published direct evidence is lacking is needed. In this paper, we provide a case example as a suggested solution following the principles of collecting expert evidence.
What is the implication/what should change now
- •
Using an expert evidence approach provides a potential solution to answer clinical dilemmas that are critical to address in clinical practice guidelines when published evidence is limited or non-existing.
- •
Other groups facing the dilemma of limited or lacking evidence should aim to identify methods that will allow for a structured and systematic summary of the collective experience of panelists.
LEGGI TUTTO https://doi.org/10.1016/j.jclinepi.2021.02.026
