GRADE workshop diagnostics

GRADE for diagnostic test and test strategies

The GRADE approach for grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions.
In the GRADE system, valid diagnostic test accuracy (DTA) studies can provide high quality evidence of test accuracy. However, tests by themselves usually affect patient important outcomes indirectly rather than directly. Tests should not be applied without carefully evaluating the intended and unintended consequences, including clinical management and outcomes that follow from applying a test. It is primarily downstream management – guided by the results of the test or a series of tests – that affects patient-important outcomes. Consequently, decisions about using a test for a specific purpose require identification of the relation between test results, downstream actions and outcomes. The GRADE for diagnosis approach provides a framework to assess, rate and link these different types of evidence.

Course objectives

After this course you:

– will be able to assess and rate the quality of evidence for a diagnostic test or test strategy and to formulate and grade a diagnostic recommendation using the GRADE approach
– will have hands-on experience in using GRADEpro | GDT software (freely available via ) for diagnostic questions (including creating an evidence profile for diagnostic test accuracy)

For whom?

  • Guideline developers
  • Systematic reviewers


The topics that will be covered are diagnostic question formulation, assessing the certainty in the evidence and creating evidence profiles for DTA studies, connecting test accuracy to patient important outcomes and moving from evidence to recommendation.


Interactive presentations and ample time for small group work using GRADEpro software.


  • Basic knowledge of developing a systematic review and the concepts of diagnostic test accuracy
  • Personal laptop to work with the online Guideline Development Tool (GDT)


1 full day (8 hours). To prepare for the course you will be asked to read a systematic review (part of the training material).


Holger Schunemann (McMaster University, co-chair GRADE working group), Miranda Langendam (AMC), Lotty Hooft and Pauline Heus (Cochrane Netherlands), Hans de Beer (Guide2Guidance) and Ton Kuijpers (NHG).


EUR 525,- per participant. The price includes coffee, lunch and training material.


10 – 18 participants.


Register for Wednesday 4 & 5June 2019, 9.30 to 17.30h, Utrecht

More information?

Miranda Langendam (; tel +31 20 566 5935)

Cancellation policy

Cancellations made up to three weeks before the start of the course will result in a full refund less €30 to cover administration costs. Refunds for cancellations received after this date will not be made.


The course will be held in English.