Table.
GRADE Evaluation of interventions for Appendicitis.
| Important outcomes | Length of hospital stay, Mortality (from appendicitis), Quality of life, Return to normal activities, Treatment success | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of surgery compared with antibiotics for acute appendicitis? | |||||||||
| at least 4 (at least 900) | Treatment success | Surgery versus antibiotics | 4 | –3 | –1 | –2 | 0 | Very low | Quality points deducted for weak methods (unclear allocation concealment, blinding, and randomisation), uncertainty of diagnosis, and incomplete reporting of results; consistency point deducted for significant heterogeneity and different outcome measures; directness points deducted for unclear clinical generalisability (unclear if antibiotics used with surgery, no comparison of optimal therapies, no outcomes beyond 1 year, predominantly males, adults only) |
| 5 (at least 900) | Mortality (from appendicitis) | Surgery versus antibiotics | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for weak methods (unclear allocation concealment, blinding, and randomisation), uncertainty of diagnosis, and incomplete reporting of results; directness points deducted for unclear clinical generalisability (unclear if antibiotics used with surgery, no comparison of optimal therapies, no outcomes beyond 1 year, predominantly males, adults only) |
| at least 4 (at least 821) | Length of hospital stay | Surgery versus antibiotics | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for weak methods (unclear allocation concealment, blinding, and randomisation), and uncertainty of diagnosis; directness points deducted for unclear exclusion of trial, and unclear clinical generalisability (unclear if antibiotics used with surgery, no comparison of optimal therapies, no outcomes beyond 1 year, predominantly males, adults only) |
| at least 3 (at least 491) | Return to normal activities | Surgery versus antibiotics | 4 | –3 | 0 | –2 | 0 | Very low | Quality points deducted for weak methods (unclear allocation concealment, blinding, and randomisation) and uncertainty of diagnosis; directness points deducted for unclear clinical generalisability (unclear if antibiotics used with surgery, no comparison of optimal therapies, no outcomes beyond 1 year, predominantly males, adults only) |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.