TY - JOUR
T1 - Defining ranges for certainty ratings of diagnostic accuracy: A GRADE concept paper.
AU - Hultcrantz, Monica
AU - Mustafa, Reem A
AU - Leeflang, Mariska M G
AU - Lavergne, Valéry
AU - Estrada-Orozco, Kelly
AU - Ansari, Mohammed T
AU - Izcovich, Ariel
AU - Singh, Jasvinder
AU - Chong, Lee Yee
AU - Rutjes, Anne
AU - Steingart, Karen
AU - Stein, Airton
AU - Sekercioglu, Nigar
AU - Rodriguez, Ingrid Arévalo
AU - Morgan, Rebecca L
AU - Guyatt, Gordon
AU - Bossuyt, Patrick
AU - Langendam, Miranda W
AU - Schünemann, Holger J
PY - 2020/1/1
Y1 - 2020/1/1
N2 - OBJECTIVETo clarify how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) concept of certainty of evidence applies to certainty ratings of test accuracy.STUDY DESIGN AND SETTINGAfter initial brainstorming with GRADE Working Group members, we iteratively refined and clarified the approaches for defining ranges when assessing the certainty of evidence for test accuracy within a systematic review, health technology assessment, or guidelines.RESULTSRanges can be defined both for single test accuracy and for comparative accuracy of multiple tests. For systematics reviews and health technology assessments, approaches for defining ranges include some that do not require value judgments regarding downstream health outcomes. Key challenges arise in the context of a guideline that requires ranges for sensitivity and specificity that are set considering possible effects on all critical outcomes. We illustrate possible approaches and provide an example from a systematic review of a direct comparison between two test strategies.CONCLUSIONSThis GRADE concept paper provides a framework for assessing, presenting, and making decisions based on the certainty of evidence for test accuracy. More empirical research is needed to support future GRADE guidance on how to best operationalize the candidate approaches.
AB - OBJECTIVETo clarify how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) concept of certainty of evidence applies to certainty ratings of test accuracy.STUDY DESIGN AND SETTINGAfter initial brainstorming with GRADE Working Group members, we iteratively refined and clarified the approaches for defining ranges when assessing the certainty of evidence for test accuracy within a systematic review, health technology assessment, or guidelines.RESULTSRanges can be defined both for single test accuracy and for comparative accuracy of multiple tests. For systematics reviews and health technology assessments, approaches for defining ranges include some that do not require value judgments regarding downstream health outcomes. Key challenges arise in the context of a guideline that requires ranges for sensitivity and specificity that are set considering possible effects on all critical outcomes. We illustrate possible approaches and provide an example from a systematic review of a direct comparison between two test strategies.CONCLUSIONSThis GRADE concept paper provides a framework for assessing, presenting, and making decisions based on the certainty of evidence for test accuracy. More empirical research is needed to support future GRADE guidance on how to best operationalize the candidate approaches.
KW - Certainty of evidence
KW - GRADE
KW - Guidelines
KW - Health technology assessments
KW - Systematic reviews
KW - Test accuracy
U2 - 10.1016/j.jclinepi.2019.05.002
DO - 10.1016/j.jclinepi.2019.05.002
M3 - Article
SN - 0895-4356
VL - 117
SP - 138
EP - 148
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -