Romina Brignardello-Petersen1, Gordon H Guyatt2, Reem A Mustafa3, Derek K Chu2, Monica Hultcrantz4, Holger J Schünemann5, George Tomlinson6. 1. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada. Electronic address: brignarr@mcmaster.ca. 2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada. 3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada; Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS 66160, United States. 4. Swedish Agency on Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden. 5. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada; Department of Medicine & Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, 79110, Germany. 6. Department of Medicine, University Health Network, Toronto, Ontario, M5G 2C4, Canada.
Abstract
OBJECTIVE: This article describes GRADE guidance for assessing imprecision when rating the certainty of the evidence from network meta-analysis. STUDY DESIGN AND SETTING: A project group within the GRADE working group conducted iterative discussions, computer simulations, and presentations at GRADE working group meetings to produce and obtain approval for this guidance. RESULTS: When addressing imprecision of a network estimate, reviewers should consider the 95% confidence or credible interval, and the optimal information size. If the 95% confidence or credible interval crosses a pre-specified threshold, reviewers should rate down the certainty of the evidence. If the 95% confidence interval does not cross any pre-specfied threshold, reviewers should consider the optimal information size. Because addressing the optimal information size may be challenging, reviewers can use the effect size to decide if any calculations are necessary. When the size of the effect is modest or the optimal information size is met, reviewers should not rate down for imprecision. CONCLUSION: Reviewers should use this guidance when to appropriately address imprecision in the context of the assessment of certainty of evidence from network meta-analysis.
OBJECTIVE: This article describes GRADE guidance for assessing imprecision when rating the certainty of the evidence from network meta-analysis. STUDY DESIGN AND SETTING: A project group within the GRADE working group conducted iterative discussions, computer simulations, and presentations at GRADE working group meetings to produce and obtain approval for this guidance. RESULTS: When addressing imprecision of a network estimate, reviewers should consider the 95% confidence or credible interval, and the optimal information size. If the 95% confidence or credible interval crosses a pre-specified threshold, reviewers should rate down the certainty of the evidence. If the 95% confidence interval does not cross any pre-specfied threshold, reviewers should consider the optimal information size. Because addressing the optimal information size may be challenging, reviewers can use the effect size to decide if any calculations are necessary. When the size of the effect is modest or the optimal information size is met, reviewers should not rate down for imprecision. CONCLUSION: Reviewers should use this guidance when to appropriately address imprecision in the context of the assessment of certainty of evidence from network meta-analysis.
Authors: Souvik Mitra; Courtney E Gardner; Abigale MacLellan; Tim Disher; Danielle M Styranko; Marsha Campbell-Yeo; Stefan Kuhle; Bradley C Johnston; Jon Dorling Journal: Cochrane Database Syst Rev Date: 2022-04-01