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783306 
Journal Article 
GRADE: An emerging consensus on rating quality of evidence and strength of recommendations 
Guyatt, GH; Oxman, AD; Vist, GE; Kunz, R; Falck-Ytter, Y; Alonso-Coello, P; Schünemann, HJ 
2008 
1 
BMJ (Clinical Research Edition)
ISSN: 0959-8138
EISSN: 1756-1833 
336 
7650 
924-926 
English 
18436948 
Guideline developers around the world are inconsistent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face challenges in understanding the messages that grading systems try to communicate. Since 2006
the BMJ has requested in its “Instructions to Authors” on bmj.com that authors should preferably use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for grading evidence when submitting a clinical guidelines article.
What was behind this decision? In this first in a series of five articles we will explain why many organisations use formal systems to grade evidence and recommendations and why this is important for clinicians; we will focus on the GRADE approach to recommendations. In the next two articles we will examine how the GRADE system categorises quality of evidence and strength of recommendations. The final two articles will focus on recommendations for diagnostic tests and GRADE’s framework for tackling
the impact of interventions on use of resources. GRADE has advantages over previous rating systems. Other systems share some of these advantages, but none, other than GRADE, combines them all.