• Nicole Boluyt, Bart L Rottier, and Miranda W Langendam.
• Academisch Medisch Centrum, Amsterdam, the Netherlands. n.boluyt@amc.uva.nl
• Ned Tijdschr Geneeskd. 2012 Jan 1; 156 (25): A4379.

AbstractGRADE (Grading of Recommendations Assessment, Development and Evaluation) is a new method to represent the quality of evidence and strength of recommendations in guidelines more transparently. In this article, we describe the benefits of GRADE as applied to a recommendation from the guideline "Treatment of asthma in children". A new feature of GRADE is that the relevant outcome criteria are specified in advance and that the quality of evidence is assessed per outcome criterion. The quality is adjusted downwards in the case of limitations in the study design and in the case of four additional factors: inconsistency, indirectness of evidence, imprecision and publication bias. The strength of the recommendation depends not only on the quality of evidence, but also on considerations such as the balance between benefits and adverse effects, patient preferences and costs. When using GRADE to formulate guidelines, these considerations are made explicit. Using GRADE can lead to different recommendations than older methods and to improved acceptance and implementation in clinical practice.

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