Gerald Gartlehner1, Andreea Dobrescu2, Tammeka Swinson Evans3, Carla Bann3, Karen A Robinson4, James Reston5, Kylie Thaler6, Andrea Skelly7, Anna Glechner6, Kimberly Peterson8, Christina Kien6, Kathleen N Lohr3. 1. Cochrane Austria, Danube University, Krems, Austria; RTI International, Research Triangle Park, NC, USA. Electronic address: gerald.gartlehner@donau-uni.ac.at. 2. Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. 3. RTI International, Research Triangle Park, NC, USA. 4. Johns Hopkins University Medical Center, Baltimore, MD, USA. 5. ECRI Institute, Plymouth Meeting, PA, USA. 6. Cochrane Austria, Danube University, Krems, Austria. 7. Spectrum Research, Inc., Tacoma, Washington. 8. Oregon Health & Science University, Portland, OR, USA.
Abstract
OBJECTIVE: To determine the predictive validity of the U.S. Evidence-based Practice Center (EPC) approach to GRADE (Grading of Recommendations Assessment, Development and Evaluation). STUDY DESIGN AND SETTING: Based on Cochrane reports with outcomes graded as high quality of evidence (QOE), we prepared 160 documents which represented different levels of QOE. Professional systematic reviewers dually graded the QOE. For each document, we determined whether estimates were concordant with high QOE estimates of the Cochrane reports. We compared the observed proportion of concordant estimates with the expected proportion from an international survey. To determine the predictive validity, we used the Hosmer-Lemeshow test to assess calibration and the C (concordance) index to assess discrimination. RESULTS: The predictive validity of the EPC approach to GRADE was limited. Estimates graded as high QOE were less likely, estimates graded as low or insufficient QOE more likely to remain stable than expected. The EPC approach to GRADE could not reliably predict the likelihood that individual bodies of evidence remain stable as new evidence becomes available. C-indices ranged between 0.56 (95% CI, 0.47 to 0.66) and 0.58 (95% CI, 0.50 to 0.67) indicating a low discriminatory ability. CONCLUSION: The limited predictive validity of the EPC approach to GRADE seems to reflect a mismatch between expected and observed changes in treatment effects as bodies of evidence advance from insufficient to high QOE.
OBJECTIVE: To determine the predictive validity of the U.S. Evidence-based Practice Center (EPC) approach to GRADE (Grading of Recommendations Assessment, Development and Evaluation). STUDY DESIGN AND SETTING: Based on Cochrane reports with outcomes graded as high quality of evidence (QOE), we prepared 160 documents which represented different levels of QOE. Professional systematic reviewers dually graded the QOE. For each document, we determined whether estimates were concordant with high QOE estimates of the Cochrane reports. We compared the observed proportion of concordant estimates with the expected proportion from an international survey. To determine the predictive validity, we used the Hosmer-Lemeshow test to assess calibration and the C (concordance) index to assess discrimination. RESULTS: The predictive validity of the EPC approach to GRADE was limited. Estimates graded as high QOE were less likely, estimates graded as low or insufficient QOE more likely to remain stable than expected. The EPC approach to GRADE could not reliably predict the likelihood that individual bodies of evidence remain stable as new evidence becomes available. C-indices ranged between 0.56 (95% CI, 0.47 to 0.66) and 0.58 (95% CI, 0.50 to 0.67) indicating a low discriminatory ability. CONCLUSION: The limited predictive validity of the EPC approach to GRADE seems to reflect a mismatch between expected and observed changes in treatment effects as bodies of evidence advance from insufficient to high QOE.
Authors: Noah C Schoenberg; Alan F Barker; John Bernardo; Robin R Deterding; Jerrold J Ellner; Dean R Hess; Neil R MacIntyre; Fernando J Martinez; Kevin C Wilson Journal: Am J Respir Crit Care Med Date: 2017-09-01 Impact factor: 21.405