Abstract
Objectives
The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) working
group has recognized some scenarios in which strong recommendations may be supported
by low-quality evidence, the so-called paradigmatic situations. The adherence to these
paradigmatic situations by the American Thyroid Association (ATA) guidelines, however,
remains unknown.
Study Design and Setting
Clinical guidelines from the ATA were retrieved and deemed eligible if created using
GRADE or the American College of Physicians (ACP) system. Reviewers, independently
and in duplicate, assessed all strong recommendations based on low-quality evidence
and judged their alignment with GRADE paradigmatic situations. The study was conducted
at KER Unit Mexico.
Results
A total of five clinical guidelines, one using the GRADE and four using the ACP system,
were eligible for analysis. We assessed a total of 518 recommendations, of which 355
(69%) were labeled as “strong” and 163 (31%) as “weak”. A total of 151 strong recommendations
were based on low-quality evidence, of which 36 (24%) were congruent with one of the
five GRADE paradigmatic situations, whereas 115 (76%) were not consistent with any
paradigmatic situations and should have been categorized as weak (23% [26/115]) or
best-practice recommendations (77% [89/115]).
Conclusion
ATA clinical guidelines are discordant with GRADE guidance. Future guidelines should
carefully evaluate the quality of evidence and recognize its limitations when developing
recommendations.
Keywords
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Article info
Publication history
Published online: March 04, 2020
Accepted:
February 9,
2020
Footnotes
Conflicts of interests: All authors have no relationships with financial/personal interests, belief, or activities that could appear to have influenced the objectivity of the submitted work. The manuscript's guarantor (RRG) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported and that no important aspects of the study have been omitted.
Disclosures: all authors declare having no conflicts of interests or financial disclosure.
Author's contributions: R.R.-G. conceived the idea. K.G.B.-O., E.G.-D.T., D.A.C.-G., and M.G.-L. extracted all data. K.G.B.-O. and E.G.D.-T. analyzed the data. K.G.B.-O. wrote the initial draft of the manuscript with input of E.G.D.-T. and R.R.-G. J.G.G.-G., K.R.-C., and M.R.G. provided substantial observations, feedback, and edition to the final draft of the article. All authors agreed on the final version of the article.
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