Recommendations for Cardiomyopathy Surveillance for Survivors of Childhood Cancer: A Report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

. Author manuscript; available in PMC: 2016 Mar 1.

Published in final edited form as: Lancet Oncol. 2015 Mar;16(3):e123–e136. doi: 10.1016/S1470-2045(14)70409-7

Conclusions of evidence	Study quality	Study findings	Wording in conclusions
A High level of evidence	Evidence from well performed and high quality studies or systematic reviews (low risk of bias, direct,^* consistent, precise)	If a risk factor is significantly associated with the outcome in ≥95% of studies	‘There is evidence that…’
B Moderate/Low level of evidence	Evidence from studies or systematic reviews with few important limitations	If a risk factor is significantly associated with the outcome in ≥50% of the studies reporting on this risk factor, and in the remaining studies this association is not significant	‘Evidence suggests that…’
C Very low level of evidence	Evidence from studies with serious flaws (high risk of bias, inconsistent, indirect^*, imprecise)	If a risk factor is significantly associated with the outcome in 1 study	‘Some evidence suggests that…’
		If a risk factor is significantly associated with the outcome in <50% of the studies, while in the remaining studies this association is not significant
		If a risk factor is significantly (either positively or negatively) associated with the outcome in >50% of the studies, while the remaining studies show the opposite association of the risk factor and outcome.
Conflicting evidence	N/A	If a risk factor is significantly (both positively and negatively) associated with the outcome in the same number of studies of comparable quality.	‘There is conflicting evidence…’
No evidence	N/A	If no studies reported on a risk factor	‘No studies reported on…’

Abbreviations: GRADE, Grading of Recommendations Assessment Development and Evaluation; N/A, not applicable.

Direct evidence comes from research that directly compares the interventions in which we are interested when applied to the populations in which we are interested and measures outcomes important to patients. Studies are indirect if there are differences in study population (our population of interest is childhood cancer survivors), interventions, or outcome measures, or if there are indirect comparisons of interventions.

Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004; 328(7454): 1490.