Table 5.

Reasons for downgrading Grades of Recommendation, Assessment, Development and Evaluation ratings for primary outcomes

	Specialty area			Intervention category
	Anaesthesia	Critical care	Emergency	Medication	Medical device	Nonpharmacological
Reasons	n = 50	n = 38	n = 6	n = 55	n = 27	n = 10
Risk of bias	23 (46)	18 (47)	3 (50)	23 (42)	14 (52)	7 (70)
Imprecision	16 (32)	17 (45)	3 (50)	17 (31)	14 (52)	5 (50)
Inconsistency	7 (14)	10 (26)	1 (17)	8 (15)	7 (26)	3 (30)
Publication bias	6 (12)	10 (26)	2 (33)	10 (18)	7 (26)	1 (10)
Indirectness	3 (6)	2 (5)	2 (33)	6 (11)	0 (0)	1 (10)

Data are given as n (%).

Columns totals are the number of reviews that used Grades of Recommendation, Assessment, Development and Evaluation and downgraded the quality of evidence. Frequencies and percentages in each column are not cumulative because a primary outcome could have been downgraded for more than one reason.