Grading in Clinical Practice Guidelines

Prof. Mary Ferrill clarifies grading in CPGs and major inconsistencies in this video.

To begin with, there are 5 grades or levels in total. Firstly, the studies in GRADE A (Level 1) are well-conducted randomized controlled clinical trials (RCTs). Their benefits are much more than risk.

Secondly, the papers in grade B (Level 2) are probably recommended, and they could be beneficial.

The lowest one goes to grade E (Level 5), and it may be some experts’ consensus or clinical practice experiences, which is not usually recommended because the risk is higher than the benefit.

Additionally, we are given several examples to understand Grade B category. In GOLD, it means when few RCTs exist, they are small in size, or they were undertaken in a population that differs from the target population of the recommendation.

Ultimately, she gives us several major inconsistencies in Leuppi, et al Study, including primary outcome not preferred measure, inadequate study duration, and no mention of ancillary medications.

Have you found any inconsistency in the study you are working on? Please share it below.