Reem A Mustafa1, Carlos A Cuello Garcia2, Meha Bhatt3, John J Riva4, Sara Vesely5, Wojtek Wiercioch3, Robby Nieuwlaat3, Payal Patel6, Sheila Hanson7, Fiona Newall8, John Wiernikowski9, Paul Monagle10, Holger J Schünemann3. 1. Department of Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada. Electronic address: rmustafa@kumc.edu. 2. Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada; Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON L8S 4L8, Canada. 3. Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada. 4. Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada; Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6, Canada. 5. Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th, Oklahoma City, OK 73104, USA. 6. Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA 30322, USA. 7. Department of Pediatrics, Medical College of Wisconsin and Critical Care Section, Children's Hospital of Wisconsin, Milwaukee, WI. 8. Department of Nursing Research, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia. 9. Division of Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada. 10. Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Abstract
OBJECTIVES: One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not exist. In this brief report (GRADE notes), we describe our method of developing evidence-based recommendations when publisheddirect evidence was lacking. STUDY DESIGN AND SETTING: When direct published literature was absent, an expert evidence survey was administered to panel members about their unpublished observations and case series. Focus was on collecting data about cases and outcome, not panel opinions. RESULTS: Out of 26 questions prioritized by the panel for pediatric venous thromboembolism, 12 had no, very limited, or very low certainty of evidence to inform them. The panel survey was administered for these questions. CONCLUSIONS: Areas of sparse evidence often reflect key questions that are critical to address in clinical practice guidelines due to the uncertainty among health care providers. The expert evidence approach used in this study is one method for panels totransparently deal with the lack of published evidence to directly inform recommendations.
OBJECTIVES: One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not exist. In this brief report (GRADE notes), we describe our method of developing evidence-based recommendations when publisheddirect evidence was lacking. STUDY DESIGN AND SETTING: When direct published literature was absent, an expert evidence survey was administered to panel members about their unpublished observations and case series. Focus was on collecting data about cases and outcome, not panel opinions. RESULTS: Out of 26 questions prioritized by the panel for pediatric venous thromboembolism, 12 had no, very limited, or very low certainty of evidence to inform them. The panel survey was administered for these questions. CONCLUSIONS: Areas of sparse evidence often reflect key questions that are critical to address in clinical practice guidelines due to the uncertainty among health care providers. The expert evidence approach used in this study is one method for panels totransparently deal with the lack of published evidence to directly inform recommendations.
Authors: Jan A C Hontelez; Caroline A Bulstra; Anna Yakusik; Erik Lamontagne; Till W Bärnighausen; Rifat Atun Journal: PLoS Med Date: 2021-11-09 Impact factor: 11.069