Table 2

Overview of the GRADE system for grading the quality of evidence: criteria for assigning grade of evidence

Criteria for assigning level of evidence

Type of evidence

     Randomized trial
High
     Observational study
Low
     Any other type of research evidence
Very low
Increase level if:

     Strong association
(+1)
     Very strong association
(+2)
     Evidence of a dose response gradient
(+1)
     Plausible confounders reduced the observed effect
(+1)
Decrease level if:

     Serious or very serious limitations to study quality
(-1) or (-2)
     Important inconsistency
(-1)
     Some or major uncertainty about directness
(-1) or (-2)
     Imprecise or sparse dataa
(-1)
     High probability of reporting bias
(-1)

aFew outcome events or observations or wide confident limits around an effect estimate. Adapted from [10].

Bellomo and Bagshaw Critical Care 2006 10:232   doi:10.1186/cc5045