LAUSR

OBJECTIVE We assessed whether guidelines published by organizations based in the United States comply with published criteria for the use of the GRADE approach. STUDY DESIGN AND SETTING We performed a cross-sectional study of all clinical practice guidelines that indicated the use of the GRADE approach, were published between 2011 and 2018 and listed in the National Guidelines Clearinghouse. RESULTS We included 67 guideline documents from 44 of 135 (32.6%) United States-based organizations that indicated the use of the GRADE approach. The majority (89.6%; 60/67) of guidelines defined the certainty of evidence consistent with GRADE but only approximately one in ten (10.4%; 7/67) explicitly reported consideration of all eight criteria to assess the certainty in the evidence for rating down and up. A majority of guidelines (53.7%; 36/67) provided a summary of the evidence, described explicit consideration of all four central domains (53.7%; 36/67) and rated the strength of recommendation consistent with GRADE (53.7%; 36/67). CONCLUSION Approximately one in three US based organizations developing evidence-based guidelines report the use of GRADE but adherence to published criteria is inconsistent. As uptake of the GRADE approach increases in the US, continued efforts to train guideline methodologists and panel members are important.