Developing trustworthy recommendations as part of an urgent response (1–2 weeks): a GRADE concept paper

Elie A. Akl, Rebecca L. Morgan, Andrew A. Rooney, Brandiese Beverly, Srinivasa Vittal Katikireddi, Arnav Agarwal, Brian S. Alper, Carlos Alva-Diaz, Laura Amato, Mohammed T. Ansari, Jan Brozek, Derek K. Chu, Philipp Dahm, Andrea J. Darzi, Maicon Falavigna, Gerald Gartlehner, Hector Pardo-Hernandez, Valerie King, Jitka Klugarová, M. W.Miranda LangendamCraig Lockwood, Manoj Mammen, Alexander G. Mathioudakis, Michael McCaul, Joerg J. Meerpohl, Silvia Minozzi, Reem A. Mustafa, Francesco Nonino, Thomas Piggott, Amir Qaseem, John Riva, Rachel Rodin, Nigar Sekercioglu, Nicole Skoetz, Gregory Traversy, Kris Thayer, Holger Schünemann

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objectives: The aim of this study is to propose an approach for developing trustworthy recommendations as part of urgent responses (1–2 week) in the clinical, public health, and health systems fields. Study Design and Setting: We conducted a review of the literature, outlined a draft approach, refined the concept through iterative discussions, a workshop by the Grading of Recommendations Assessment, Development and Evaluation Rapid Guidelines project group, and obtained feedback from the larger Grading of Recommendations Assessment, Development and Evaluation working group. Results: A request for developing recommendations within 2 week is the usual trigger for an urgent response. Although the approach builds on the general principles of trustworthy guideline development, we highlight the following steps: (1) assess the level of urgency; (2) assess feasibility; (3) set up the organizational logistics; (4) specify the question(s); (5) collect the information needed; (6) assess the adequacy of identified information; (7) develop the recommendations using one of the 4 potential approaches: adopt existing recommendations, adapt existing recommendations, develop new recommendations using existing adequate systematic review, or develop new recommendations using expert panel input; and (8) consider an updating plan. Conclusion: An urgent response for developing recommendations requires building a cohesive, skilled, and highly motivated multidisciplinary team with the necessary clinical, scientific, and methodological expertise; adapting to shifting needs; complying with the principles of transparency; and properly managing conflicts of interest.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Clinical Epidemiology
StatePublished - Jan 2021


  • Pandemic
  • Trustworthy guideline
  • Urgent recommendation


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