TY - JOUR
T1 - Using explicit thresholds for benefits and harms in partially contextualized GRADE guidelines. Pilot experience from a living COVID-19 guideline
AU - Neumann, Ignacio
AU - Quiñelen, Eduardo
AU - Nahuelhual, Paula
AU - Burdiles, Pamela
AU - Celedón, Natalia
AU - Cerda, Katherine
AU - Herrera-Omegna, Paloma
AU - Kraemer, Patricia
AU - Cancino, Karen Dominguez
AU - Valenzuela, Juan Pablo
AU - Sepúlveda, Dino
AU - Morgano, Gian Paolo
AU - Akl, Elie A.
AU - Schünemann, Holger J.
N1 - Funding Information:
Conflict of interest: This work had no specific funding. All authors declare no conflict of interest.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/7
Y1 - 2022/7
N2 - Objectives: Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. Study Design and Setting: We piloted the use of thresholds in a Chilean COVID-19 living guideline. For each of the critical outcomes, we asked panelists to suggest values of the thresholds for large, moderate, small, or trivial or no effect. We collected this information through a survey and an on-line discussion. Results: Twelve panelists decided on thresholds for three critical outcomes (mortality, need for mechanical ventilation and serious adverse events). For all outcomes, an absolute risk reduction was considered larger with more than 50 events, moderate with less than 50 events, small with less than 25 events, and trivial with less than 10 events. Having these a priori thresholds in place significantly impacted on the development of recommendations. Conclusion: Explicit thresholds were a valuable addition to the judgment of the certainty in the evidence, to decide the direction and strength of the recommendation and to evaluate the need for update. We believe this is a line of research worth perusing.
AB - Objectives: Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. Study Design and Setting: We piloted the use of thresholds in a Chilean COVID-19 living guideline. For each of the critical outcomes, we asked panelists to suggest values of the thresholds for large, moderate, small, or trivial or no effect. We collected this information through a survey and an on-line discussion. Results: Twelve panelists decided on thresholds for three critical outcomes (mortality, need for mechanical ventilation and serious adverse events). For all outcomes, an absolute risk reduction was considered larger with more than 50 events, moderate with less than 50 events, small with less than 25 events, and trivial with less than 10 events. Having these a priori thresholds in place significantly impacted on the development of recommendations. Conclusion: Explicit thresholds were a valuable addition to the judgment of the certainty in the evidence, to decide the direction and strength of the recommendation and to evaluate the need for update. We believe this is a line of research worth perusing.
KW - Clinical guidelines
KW - COVID-19
KW - GRADE
UR - http://www.scopus.com/inward/record.url?scp=85129247343&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2022.03.017
DO - 10.1016/j.jclinepi.2022.03.017
M3 - Artículo
C2 - 35364230
AN - SCOPUS:85129247343
SN - 0895-4356
VL - 147
SP - 69
EP - 75
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -