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