Systems for grading the quality of evidence and the strength of recommendations II: Pilot study of a new system

Atkins, David; Briss, Peter A; Eccles, Martin; Flottorp, Signe; Guyatt, Gordon H; Harbour, Robin T; Hill, Suzanne; Jaeschke, Roman; Liberati, Alessandro; Magrini, Nicola; Mason, James; O'Connell, Dianne; Oxman, Andrew D; Phillips, Bob; Schünemann, Holger; Edejer, Tessa Tan-Torres; Vist, Gunn E; Williams, John W

doi:10.1186/1472-6963-5-25

BMC Health Services Research

Table 9 Example of a modified GRADE evidence profile quality assessment. Table 9 and 10 is what Table 1 and 2 became when including the improvements made based on the pilot study experience.

From: Systems for grading the quality of evidence and the strength of recommendations II: Pilot study of a new system

Outcome: Depression severity (measured with Hamilton Depression Rating Scale after 4 to 12 weeks)
Studies	Design	Quality	Consistency	Directness	SD	SA	RB	DR	PC
8 trials Citalopram 38 trials Fluoxetine 25 trials Fluvoxamine 2 trials Nefazodone 18 trials Paroxetine 4 trials Sertaline 4 trials Velafaxine	RCTs	No serious limitations	No important inconsistency	Some uncertainty about directness (outcome measure)*	No	No	No	No	No
Outcome: Transient side effects resulting in discontinuation of treatment
8 trials Citalopram 50 trials Fluoxetine 27 trials Fluvoxamine 4 trials Nefazodone 23 trials Paroxetine 6 trials Sertaline 5 trials Velafaxine	RCTs	No serious limitations	No important inconsistency	Direct	No	No	No	No	No
Outcome: Poisoning fatalities
Office for National Statistics (British)	Observational data	Serious limitation**	Only one study	Direct	No	++	No	No	No

*There was uncertainty about the directness of the outcome measure because of the short duration of the trials.
**It is possible that people at lower risk were more likely to have been given SSRI's and it is uncertain if changing antidepressant would have deterred suicide attempts.
SD = Sparse data (Yes or No)
SA = Strong association (No, + = strong, ++ = very strong)
RB = Reporting bias (Yes or No)
DR = Dose response (Yes or No)
PC = All plausible confounders would have reduced the effect (Yes or No)
CI = confidence interval
WMD = weighted mean difference
RRR = relative risk reduction

Question: Should depressed patients be treated with SSRIs rather than tricyclics?Setting: Primary carePatients: Moderately depressed adult patientsReference: North of England Evidence Based Guideline Development Project. Evidence based clinical practice guideline: the choice of antidepressants for depression in primary care. Newcastle upon Tyne: Centre for Health Services Research, 1997.

Back to article page

ISSN: 1472-6963

Contact us

General enquiries: journalsubmissions@springernature.com