Evidence Rating
The team then used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to rate strengths and limitations. Evidence quality with GRADE is evaluated by examining methodological flaws, consistency, directness, and effect size.17,18 This tool has been successfully used in other reviews of studies in the field of pediatric oncology19,20 and includes four evaluation ratings (high, moderate, low and very low) (Table 3). One team member initially evaluated and rated each of the 14 selected records. Matrix tables including GRADE scores were developed and discussed during scheduled on-line conference calls with all research team members. All team members evaluated each article and the GRADE rating level of evidence for each article was discussed until 100% consensus was reached.17