# GRADE Summary of Findings Table Template

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Usage: Use this template to summarize evidence certainty per outcome.
Reference: GRADE Working Group methodology
Save to: RESEARCH/[topic]/grade_sof.md
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# GRADE Summary of Findings

## Review: [Your Review Title]
## Comparison: [Intervention] vs [Comparator]
## Date: [Date]

---

## Summary of Findings Table

| Outcome | № of participants (studies) | Certainty of evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
|---------|----------------------------|-------------------------------|--------------------------|------------------------------|--|
| | | | | **Risk with [Comparator]** | **Risk difference with [Intervention]** |
| [Outcome 1] | N (k studies) | ⊕⊕⊕⊕/⊕⊕⊕○/⊕⊕○○/⊕○○○ | RR/OR (CI) | X per 1,000 | Y fewer/more per 1,000 (CI) |
| [Outcome 2] | N (k studies) | | | | |
| [Outcome 3] | N (k studies) | | | | |

---

## Certainty of Evidence Symbols

| Symbol | Level | Definition |
|--------|-------|------------|
| ⊕⊕⊕⊕ | High | Very confident that the true effect lies close to the estimate |
| ⊕⊕⊕○ | Moderate | Moderately confident; true effect is likely close to the estimate but may be substantially different |
| ⊕⊕○○ | Low | Limited confidence; true effect may be substantially different from the estimate |
| ⊕○○○ | Very Low | Very little confidence; true effect is likely substantially different from the estimate |

---

## Detailed GRADE Assessment

### Outcome 1: [Outcome Name]

**Importance:** Critical / Important / Not important

| Domain | Assessment | Downgrade? | Rationale |
|--------|------------|------------|-----------|
| **Risk of bias** | Not serious / Serious / Very serious | 0 / -1 / -2 | [Explain based on RoB assessments] |
| **Inconsistency** | Not serious / Serious / Very serious | 0 / -1 / -2 | I² = X%; [interpretation] |
| **Indirectness** | Not serious / Serious / Very serious | 0 / -1 / -2 | [Population/intervention/outcome differences] |
| **Imprecision** | Not serious / Serious / Very serious | 0 / -1 / -2 | [CI width, sample size, OIS] |
| **Publication bias** | Undetected / Strongly suspected | 0 / -1 | [Funnel plot, statistical tests] |

| Domain | Assessment | Upgrade? | Rationale |
|--------|------------|----------|-----------|
| **Large effect** | No / Yes | 0 / +1 / +2 | RR > 2 or < 0.5 |
| **Dose-response** | No / Yes | 0 / +1 | [Gradient evidence] |
| **Plausible confounding** | No / Yes | 0 / +1 | [Would reduce effect if present] |

**Starting grade:** High (for RCTs) / Low (for observational)

**Downgrades:** [List domains and reasons]

**Upgrades:** [List domains and reasons, if applicable]

**Final certainty:** ⊕⊕⊕⊕ High / ⊕⊕⊕○ Moderate / ⊕⊕○○ Low / ⊕○○○ Very Low

---

### Outcome 2: [Outcome Name]

[Repeat structure above]

---

## GRADE Domains Explained

### Downgrade Factors

#### 1. Risk of Bias
| Situation | Downgrade |
|-----------|-----------|
| Most studies at low risk | None |
| Some studies at high risk, but not majority | -1 (Serious) |
| Most studies at high risk | -2 (Very serious) |

#### 2. Inconsistency
| Situation | Downgrade |
|-----------|-----------|
| I² < 40%, overlapping CIs | None |
| I² 40-75%, some unexplained heterogeneity | -1 (Serious) |
| I² > 75%, unexplained heterogeneity | -2 (Very serious) |

#### 3. Indirectness
| Type | Examples |
|------|----------|
| Population | Different age, severity, setting |
| Intervention | Different dose, duration, delivery |
| Comparator | Active vs placebo differences |
| Outcome | Surrogate vs patient-important |

#### 4. Imprecision
| Situation | Downgrade |
|-----------|-----------|
| Adequate sample size, narrow CI | None |
| CI crosses clinical decision threshold | -1 (Serious) |
| Wide CI, very small sample | -2 (Very serious) |

**Optimal Information Size (OIS):** Sample size that would be adequate for a well-powered RCT

#### 5. Publication Bias
| Indicators | Assessment |
|------------|------------|
| Asymmetric funnel plot | Suspected |
| Statistical tests (Egger's) p < 0.1 | Suspected |
| Few studies, all industry-funded | Suspected |
| Comprehensive search, preregistration | Unlikely |

### Upgrade Factors (Observational Studies Only)

| Factor | When to Upgrade |
|--------|-----------------|
| Large effect | RR > 2 or < 0.5 with no confounding (+1); RR > 5 or < 0.2 (+2) |
| Dose-response | Clear gradient observed |
| Confounding | All plausible confounders would reduce effect |

---

## Evidence Profile

| Outcome | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other | Overall certainty |
|---------|--------------|--------------|---------------|--------------|-------------|-------|-------------------|
| [Outcome 1] | RCT / Obs | ↓ / ↓↓ / — | ↓ / ↓↓ / — | ↓ / ↓↓ / — | ↓ / ↓↓ / — | ↓ / ↑ / — | ⊕⊕⊕⊕/⊕⊕⊕○/⊕⊕○○/⊕○○○ |
| [Outcome 2] | | | | | | | |

**Legend:**
- ↓ = Downgraded one level (Serious)
- ↓↓ = Downgraded two levels (Very serious)
- ↑ = Upgraded one level
- — = No change

---

## Plain Language Summary

### What we found

[2-3 sentences summarizing key findings in plain language]

### Certainty of evidence

- **[Outcome 1]**: We are [very confident / moderately confident / have limited confidence / have very little confidence] that [finding].
- **[Outcome 2]**: [Same structure]

### What this means

[Implications for practice/policy in plain language]

---

## Footnotes

1. [Explanation for specific downgrade/upgrade decisions]
2. [Additional context]

---

*GRADE assessment completed: [Date]*
*Assessor(s): [Name(s)]*

*Reference: Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook. Available at: https://gdt.gradepro.org/app/handbook/handbook.html*
