About
- This ACIP GRADE handbook provides guidance to the ACIP workgroups on how to use the GRADE approach for assessing the certainty of evidence.
Summary
Clear and standardized wording helps to communicate the findings from GRADE Summary of Findings or GRADE Evidence Profiles. Statements to communicate the findings are informed by the certainty of the evidence for the outcome and the size of the effect. Table 16 below provides suggested wording to convey the findings.
Table 16. Suggested narrative statements for phrasing conclusions
References in this table: 1
| Size of the effect estimate | Suggested statements for conclusions (replace X with intervention, choose ‘reduce’ or ‘increase’ depending on the direction of the effect, replace ‘outcome’ with name of outcome, include ‘when compared with Y’ when needed) |
|---|---|
| High certainty of the evidence | |
| Large effect | X results in a large reduction/increase in outcome |
| Moderate effect | X reduces/increases outcome
X results in a reduction/increase in outcome
|
| Small important effect | X reduces/increases outcome slightly
X results in a slight reduction/increase in outcome
|
| Trivial, small unimportant effect or no effect | X results in little to no difference in outcome
X does not reduce/increase outcome |
| Moderate certainty of the evidence | |
| Large effect | X likely results in a large reduction/increase in outcome
X probably results in a large reduction/increase in outcome
|
| Moderate effect | X likely reduces/increases outcome
X probably reduces/increases outcome
X likely results in a reduction/increase in outcome
X probably results in a reduction/increase in outcome
|
| Small important effect | X probably reduces/increases outcome slightly
X likely reduces/increases outcome slightly X probably results in a slight reduction/increase in outcome
X likely results in a slight reduction/increase in outcome
|
| Trivial, small unimportant effect or no effect | X likely results in little to no difference in outcome
X probably results in little to no difference in outcome
X likely does not reduce/increase outcome
X probably does not reduce/increase outcome
|
| Low certainty of the evidence | |
| Large effect | X may result in a large reduction/increase in outcome
The evidence suggests X results in a large reduction/increase in outcome
|
| Moderate effect | X may reduce/increase outcome
The evidence suggests X reduces/increases outcome
X may result in a reduction/increase in outcome
The evidence suggests X results in a reduction/increase in outcome
|
| Small important effect | X may reduce/increase outcome slightly
The evidence suggests X reduces/increases outcome slightly
X may result in a slight reduction/increase in outcome
The evidence suggests X results in a slight reduction/increase in outcome
|
| Trivial, small unimportant effect or no effect | X may result in little to no difference in outcome
The evidence suggests that X results in little to no difference in outcome
X may not reduce/increase outcome
The evidence suggests that X does not reduce/increase outcome
|
| Very low certainty of the evidence | |
| Any effect | The evidence is very uncertain about the effect of X on outcome
X may reduce/increase/have little to no effect on outcome, but the evidence is very uncertain
|
- Holger J Schünemann GEV, Julian PT Higgins, Nancy Santesso, Jonathan J Deeks, Paul Glasziou, Elie A Akl, Gordon H Guyatt. Chapter 15: Interpreting results and drawing conclusions. Cochrane Handbook for Systematic Reviews of Interventions 2023;