Using Explicit Thresholds were valuable for judging Benefits and Harms in partially contextualized GRADE Guidelines

Area of Science:

• Clinical guidelines
• Health technology assessment
• Evidence-based medicine

Background:

• Guideline panels often lack explicit thresholds for assessing health benefits and harms.
• This absence can hinder the development of sensible and consistent recommendations.

Purpose of the Study:

• To pilot the use of explicit thresholds for benefits and harms in a clinical guideline.
• To evaluate the impact of these thresholds on the recommendation development process.

Main Methods:

• A Chilean COVID-19 living guideline panel piloted the use of benefit and harm thresholds.
• Panelists defined thresholds for critical outcomes (mortality, mechanical ventilation, serious adverse events) using surveys and online discussions.

Main Results:

• Twelve panelists established thresholds for absolute risk reduction for key outcomes.
• A priori thresholds significantly influenced the development of guideline recommendations.

Conclusions:

• Explicit thresholds enhance certainty in evidence assessment, recommendation strength, and update evaluation.
• This methodology represents a valuable area for future research in guideline development.