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首页> 外文期刊>Allergy >Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies.
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Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies.

机译：证据质量的分级和临床实践指南中建议的强度：第2部分，共3部分。GRADE方法对诊断测试和策略的证据质量进行分级。

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摘要

The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions. In the GRADE system, valid diagnostic accuracy studies can provide high quality evidence of test accuracy. However, such studies often provide only low quality evidence for the development of recommendations about diagnostic testing, as test accuracy is a surrogate for patient-important outcomes at best. Inferring from data on accuracy that using a test improves outcomes that are important to patients requires availability of an effective treatment, improved patients' wellbeing through prognostic information, or - by excluding an ominous diagnosis - reduction of anxiety and the opportunity for earlier search for an alternative diagnosis for which beneficial treatment can be available. Assessing the directness of evidence supporting the use of a diagnostic test requires judgments about the relationship between test results and patient-important consequences. Well-designed and conducted studies of allergy tests in parallel with efforts to evaluate allergy treatments critically will encourage improved guideline development for allergic diseases.
机译：GRADE对证据质量和推荐强度进行分级的方法为开发有关使用诊断测试或诊断策略的临床推荐提供了一种全面透明的方法。尽管对证据质量和使用测试的建议强度进行评级具有对治疗建议进行评级的逻辑，但它也带来了独特的挑战。当使用有关测试准确性的证据作为临床决策的基础时，指南小组和临床医生应警惕这些特殊挑战。在GRADE系统中，有效的诊断准确性研究可以提供测试准确性的高质量证据。但是，此类研究通常仅提供质量低下的证据，无法提出有关诊断测试的建议，因为测试准确性充其量只能作为对患者至关重要的结果的替代。从准确性的数据推断，使用测试可以改善对患者重要的结局，这需要提供有效的治疗方法，通过预后信息来改善患者的健康状况，或者-通过排除不祥的诊断-减轻焦虑症并有机会早日寻求治疗方法。可以进行有益治疗的替代诊断。要评估支持使用诊断测试的证据的直接性，就需要对测试结果与患者重要后果之间的关系做出判断。精心设计和进行的过敏试验研究，以及对过敏疗法进行严格评估的努力，将鼓励改善过敏性疾病的指南制​​定。

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