Using Explicit Thresholds were valuable for judging Benefits and Harms in partially contextualized GRADE Guidelines

Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. We piloted the use of thresholds in a Chilean COVID-19 liv...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical epidemiology 2022-07, Vol.147, p.69-75
Main Authors: Neumann, Ignacio, Quiñelen, Eduardo, Nahuelhual, Paula, Burdiles, Pamela, Celedón, Natalia, Cerda, Katherine, Herrera-Omegna, Paloma, Kraemer, Patricia, Cancino, Karen Dominguez, Valenzuela, Juan Pablo, Sepúlveda, Dino, Morgano, Gian Paolo, Akl, Elie A., Schünemann, Holger J.
Format: Article
Language:English
Subjects:
Chile
Clinical guidelines
Clinical practice guidelines
Confidence
Coronaviruses
COVID-19
Epidemiology
Estimates
GRADE
Hospitalization
Humans
Intervention
Mechanical ventilation
Mortality
Other GRADE Papers
Patients
Research Report
Risk management
Risk reduction
Thresholds
Ventilators
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Guideline panels must assess the magnitude of health benefits and harms to develop sensible recommendations. However, they rarely use explicit thresholds. In this paper we report on the piloting and the use thresholds for benefits and harms. We piloted the use of thresholds in a Chilean COVID-19 living guideline. For each of the critical outcomes, we asked panelists to suggest values of the thresholds for large, moderate, small, or trivial or no effect. We collected this information through a survey and an on-line discussion. Twelve panelists decided on thresholds for three critical outcomes (mortality, need for mechanical ventilation and serious adverse events). For all outcomes, an absolute risk reduction was considered larger with more than 50 events, moderate with less than 50 events, small with less than 25 events, and trivial with less than 10 events. Having these a priori thresholds in place significantly impacted on the development of recommendations. Explicit thresholds were a valuable addition to the judgment of the certainty in the evidence, to decide the direction and strength of the recommendation and to evaluate the need for update. We believe this is a line of research worth perusing.
ISSN:0895-4356
1878-5921
DOI:10.1016/j.jclinepi.2022.03.017