Table 9.
Example of a modified GRADE evidence profile quality assessment. Table 9 and 10 is what Table 1 and 2 became when including the improvements made based on the pilot study experience.
Question: Should depressed patients be treated with SSRIs rather than tricyclics?
Setting: Primary care
Patients: Moderately depressed adult patients
Reference: North of England Evidence Based Guideline Development Project. Evidence based clinical practice guideline: the choice of antidepressants for depression in primary care. Newcastle upon Tyne: Centre for Health Services Research, 1997.
| Outcome: Depression severity (measured with Hamilton Depression Rating Scale after 4 to 12 weeks) | |||||||||
| Studies | Design | Quality | Consistency | Directness | SD | SA | RB | DR | PC |
| 8 trials Citalopram 38 trials Fluoxetine 25 trials Fluvoxamine 2 trials Nefazodone 18 trials Paroxetine 4 trials Sertaline 4 trials Velafaxine |
RCTs | No serious limitations | No important inconsistency | Some uncertainty about directness (outcome measure)* | No | No | No | No | No |
| Outcome: Transient side effects resulting in discontinuation of treatment | |||||||||
| 8 trials Citalopram 50 trials Fluoxetine 27 trials Fluvoxamine 4 trials Nefazodone 23 trials Paroxetine 6 trials Sertaline 5 trials Velafaxine |
RCTs | No serious limitations | No important inconsistency | Direct | No | No | No | No | No |
| Outcome: Poisoning fatalities | |||||||||
| Office for National Statistics (British) | Observational data | Serious limitation** | Only one study | Direct | No | ++ | No | No | No |
*There was uncertainty about the directness of the outcome measure because of the short duration of the trials.
**It is possible that people at lower risk were more likely to have been given SSRI's and it is uncertain if changing antidepressant would have deterred suicide attempts.
SD = Sparse data (Yes or No)
SA = Strong association (No, + = strong, ++ = very strong)
RB = Reporting bias (Yes or No)
DR = Dose response (Yes or No)
PC = All plausible confounders would have reduced the effect (Yes or No)
CI = confidence interval
WMD = weighted mean difference
RRR = relative risk reduction