Developing guidelines in geriatric surgery: role of the grade system

In making healthcare management decisions, clinicians must weigh up the benefits and the harms of alternative strategies. Guidelines are useful tools for administrators, policy makers, managers, clinical leaders and care givers to achieve this aim. Guidelines recommendations may be produced in three different ways: small panels of experts, consensus conferences and on the basis of evidence. Expert clinicians and organisations offering recommendations to the clinical community have often erred as a result of not taking sufficient account of evidence. Moreover the so-called "evidence-based guidelines" are often inconsistent in how they rate the quality of evidence and the strength of recommendation. Systems used to assess quality of evidence in guidelines were only scales that reported the study design the evidence was provided from as a letter or a number (i.e. C1, IIb, etc).