• Holger J Schünemann, Reem A Mustafa, Jan Brozek, Karen R Steingart, Mariska Leeflang, Mohammad Hassan Murad, Patrick Bossuyt, Paul Glasziou, Roman Jaeschke, Stefan Lange, Joerg Meerpohl, Miranda Langendam, Monica Hultcrantz, Gunn E Vist, Elie A Akl, Mark Helfand, Nancy Santesso, Lotty Hooft, Rob Scholten, Måns Rosen, Anne Rutjes, Mark Crowther, Paola Muti, Heike Raatz, Mohammed T Ansari, John Williams, Regina Kunz, Jeff Harris, Ingrid Arévalo Rodriguez, Mikashmi Kohli, Gordon H Guyatt, and GRADE Working Group.
• Department of Health Research Methods, Evidence, and Impact, McMaster GRADE Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada; Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4K1, Canada. Electronic address: schuneh@mcmaster.ca.
• J Clin Epidemiol. 2020 Jun 1; 122: 142-152.

ObjectivesThis article provides updated GRADE guidance about how authors of systematic reviews and health technology assessments and guideline developers can rate the certainty of evidence (also known as quality of the evidence or confidence in the estimates) of a body of evidence addressing test accuracy (TA) on the domains imprecision, inconsistency, publication bias, and other domains. It also provides guidance for how to present synthesized information in evidence profiles and summary of findings tables.Study Design And SettingWe present guidance for rating certainty in TA in clinical and public health and review the presentation of results of a body of evidence regarding tests.ResultsSupplemented by practical examples, we describe how raters of the evidence can apply the GRADE domains inconsistency, imprecision, and publication bias to a body of evidence of TA studies.ConclusionUsing GRADE in Cochrane and other reviews as well as World Health Organization and other guidelines helped refining the GRADE approach for rating the certainty of a body of evidence from TA studies. Although several of the GRADE domains (e.g., imprecision and magnitude of the association) require further methodological research to help operationalize them, judgments need to be made on the basis of what is known so far.Copyright © 2020 Elsevier Inc. All rights reserved.

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