UpToDate te ayuda a decidir el tratamiento con las recomendaciones evaluadas (GRADE)

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UpToDate ha adoptado el enfoque GRADE para clasificar tanto la solidez de las recomendaciones como la calidad de la información subyacente. Actualmente UpToDate incluye más de 9.000 recomendaciones evaluadas. Para consultar las recomendaciones evaluadas de un tema, hay que pulsar en el botón “Resumen y recomendaciones” en la parte superior del índice del tema (imagen)

Las evaluaciones constan de dos componentes: un número (1 o 2) que refleja la solidez de la recomendación y una letra (A, B o C) la cual refleja la calidad de la evidencia que apoya dicha recomendación:

Grade of Recommendation Clarity of risk/benefit Quality of supporting evidence Implications
1A.

Strong recommendation. High quality evidence

Benefits clearly outweigh risk and burdens, or vice
versa
Consistent evidence from well performed randomized,
controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our
confidence in the estimate of benefit and risk.
Strong recommendation, can apply to most patients in
most circumstances without reservation
1B.

Strong recommendation. Moderate quality evidence

Benefits clearly outweigh risk and burdens, or vice
versa
Evidence from randomized, controlled trials with
important limitations (inconsistent results, methodologic
flaws, indirect or imprecise), or very strong evidence of some other
form. Further research (if performed) is likely to have an impact on
our confidence in the estimate of benefit and
risk and may change the estimate.
Strong recommendation, likely to apply to most
patients
1C.

Strong recommendation. Low quality evidence

Benefits appear to outweigh risk and burdens, or
vice versa
Evidence from observational studies, unsystematic
clinical experience, or from randomized, controlled trials with serious
flaws. Any estimate of effect is uncertain.
Relatively strong recommendation; might change when
higher quality evidence becomes available
2A.

Weak recommendation. High quality evidence

Benefits closely balanced with risks and burdens Consistent evidence from well performed randomized,
controlled trials or overwhelming evidence of some other form.
Further research is unlikely to change our
confidence in the estimate of benefit and risk.
Weak recommendation, best action may differ
depending on circumstances or patients or societal values
2B.

Weak recommendation. Moderate quality evidence

Benefits closely balanced with risks and burdens,
some uncertainly in the estimates of benefits, risks and burdens
Evidence from randomized, controlled trials with
important limitations (inconsistent results, methodologic
flaws, indirect or imprecise), or very strong evidence of some other form.
Further research (if performed) is likely to have an impact on our confidence
in the estimate of benefit and risk and may change the estimate.
Weak recommendation, alternative approaches likely
to be better for some patients under some circumstances
2C.

Weak recommendation. Low quality evidence

Uncertainty in the estimates of benefits, risks, and
burdens; benefits may be closely balanced with risks and burdens
Evidence from observational studies, unsystematic
clinical experience, or from randomized, controlled trials with serious
flaws. Any estimate of effect is uncertain.
Very weak recommendation; other alternatives may be
equally re

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