1. A modeling approach to derive baseline risk estimates for GRADE recommendations: Concepts, development, and results of its application to the American Society of Hematology 2019 guidelines on prevention of venous thromboembolism in surgical hospitalized patients
- Author
-
Robby Nieuwlaat, Holger J. Schünemann, Jan Brozek, Nancy Santesso, Andrea Darzi, Philipp Dahm, Adolph J. Yates, Itziar Exteandia-Ikobaltzeta, Adam Cuker, Gian Paolo Morgano, Frederick B. Rogers, Kari A.O. Tikkinen, Feng Xie, Anita Rajasekhar, Juan José Yepes-Nuñez, Elie A. Akl, Wojtek Wiercioch, David Anderson, and Maryam Rahman
- Subjects
medicine.medical_specialty ,Models, Statistical ,Epidemiology ,Hospitalized patients ,business.industry ,Baseline risk ,Venous Thromboembolism ,Guideline ,030204 cardiovascular system & hematology ,Risk Assessment ,3. Good health ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Practice Guidelines as Topic ,medicine ,Humans ,Medical physics ,030212 general & internal medicine ,business ,Venous thromboembolism ,Surgical patients - Abstract
Objective The goal of this study was to develop an approach that can be used where baseline risk estimates that are directly applicable to prioritized patient-important outcomes are not available from published studies. Study design The McMaster University GRADE Centre and the ASH guideline panel for the prevention of VTE in surgical patients developed a modeling approach based on explicit assumptions about the distribution of symptoms, anatomical location, and severity of VTE events. Results We applied the approach to derive modeled estimates of baseline risk. These estimates were used to calculated absolute measures of anticipated effects that informed the discussion of the evidence and the formulation of 30 guideline recommendations. Conclusion Our approach can assist guideline developers facing a lack of information about baseline risk estimates that directly apply to outcomes of interest. The use of modeled estimates increases transparency in the process and makes the baseline risk used by guideline experts explicit during their decision-making.
- Published
- 2021
- Full Text
- View/download PDF