GRADE FOR DIAGNOSIS

Background
Clinicians, healthcare workers and guideline developers have to take many decisions
regarding the application of diagnostic tests. For such decisions knowledge of the accuracy
of tests is necessary. Diagnostic test accuracy (DTA) applies to comparing the results of the
test under study (the so-called index test) with those of a reference standard (the best test
to identify the patient's condition). From this various diagnostic accuracy parameters can be
derived, such as sensitivity, specificity and predictive values.
To help making diagnostic decisions systematically summarising and grading DTA evidence
has become a major part of medical decision making. Part of this summarizing process is
assigning levels of evidence to the various diagnostic outcomes and going from evidence to
recommendation. GRADE is a method that provides a framework to both these aspects of
decicion making.
This workshop is targeted at people who need to make decisions about diagnostic tests and
addresses applying GRADE to diagnostic evidence.
Objectives
The objective of this one-day workshop is to learn all aspects of applying GRADE to a body of
diagnostic evidence. GRADE (gradeworkinggroup.org) is recognised as the leading method of
appraising the level of evidence to outcomes that are critical for making clinical decisions
and recommendations. Applying GRADE for diagnostic evidence, however, is more
challenging and requires the incorporation of at least two layers of evidence: DTA evidence
and evidence regarding the downstream consequences of testing for the patient important
outcomes. On the basis of an exemplary diagnostic review, participants will create a
diagnostic evidence profi le, and develop an evidence-based recommendation according to a
framework for going from evidence to decision.
After successful completion of the workshop, participants will:
1. know the principles of the GRADE approach;
2. be able to prepare a Summary of Findings Table for diagnostic evidence;
3. be able to assign Levels of Evidence to a body of diagnostic evidence according to GRADE
(evidence profile);
4. understand that making clinical decisions about diagnostic tests requires inferences
about downstream consequences of testing and linking evidence regarding patient
important outcomes to DTA results;
5. be able formulate recommendations about the application of diagnostic tests by
applying a GRADE framework for going from evidence to decision.
Target audience
The workshop is not only directed at guideline developers and policy makers, but also at
healthcare workers, clinicians and researchers, who wish to learn more about preparing
Summary of Findings Tables and applying GRADE for diagnostic questions in systematic
reviews or daily practice.
Prerequisites
1. Participants are asked to familiarise themselves with the overview of Leeflang and
colleagues, Ann Int Med 2008;149:889-97 (freely available via
http://www.ncbi.nlm.nih.gov/pubmed/19075208).
2. Some familiarity with guideline processes would be helpful.

Topics
Introduction to GRADE.
Preparing an evidence profile and Summary of Findings Table according to GRADE for
diagnosis.
Formulating conclusions.
From evidence to decision.
Workshop Style
The workshop will consist of interactive, plenary presentations with ample room for
discussion, and small group exercises.
Faculty
Prof. Holger Schnemann, MD, PhD, McMaster University, Co-Chair GRADE Working
Group, Hamilton, Canada.
Joerg Meerpohl, MD, PhD, co-director German Cochrane Center, director GRADE Center
Freiburg, Freiburg, Germany.
From the Dutch GRADE Network (to be established):
Lotty Hooft, PhD, Dutch Cochrane Centre and Julius Center, Utrecht.
Miranda Langendam, PhD, Academic Medical Center, Amsterdam.
Rob Scholten, MD, PhD, Dutch Cochrane Centre and Julius Center, Utrecht.
Language
English.
Date
March 9, 2015, Descartes Center, University of Utrecht.
Course fee
325 (25% discount for employees of the UMC Utrecht)

For more information

Send an e-mail with your question(s) to cochrane@umcutrecht.nl
Dutch Cochrane Centre
Julius Center, University Medical Center Utrecht
Huispostnr. Str. 6.131
P.O. Box 85500
3508 GA UTRECHT
The Netherlands
P:
+31 88 755 9301
E:
cochrane@umcutrecht.nl
W:
www.cochrane.nl