正确理解和应用低质量证据形成指南推荐意见

How to Correctly Understand and Use the Low-quality Evidence to Formulate Recommendations in Guidelines

摘要: 推荐意见是临床实践指南的核心。基于低质量证据作出强推荐意见是当前国内外指南普遍存在的现象。医务人员认为缺乏高质量的证据就无法制订高质量的指南或仅可制订专家共识是典型的误解。本文以GRADE分级系统为切入点, 阐述低质量证据的基本内涵和临床作用, 介绍基于低质量证据形成指南推荐意见的方法, 以期为我国指南制订者和使用者提供参考。

Abstract: The essence of clinical practice guidelines lies in their recommendations. It is common to find strong recommendations supported by low-quality evidence in current published guidelines. There is a typical misunderstanding among medical professionals that without high-quality evidence, it is impossible to develop high-quality guidelines or only expert consensus can be developed. Based on the GRADE approach, this paper explains the concept and clinical significance of low-quality evidence, and introduces the methods for formulating recommendations based on low-quality evidence in guidelines, with the aim to provide reference for guideline developers and users in China.