Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive

I read with interest the article by Jaeschke and colleagues (1) about
the use of the GRADE grid and the polling procedures used for the
development of a new version of the Surviving Sepsis Campaign practice
guideline (2). If recommendations for daily practice should base on (high)
scientific evidence I am doubtful if the campaign will reach their goals.

The use of the GRADE grid will be useful for visualisation of meanings but
not for assessing the evidence. Furthermore I am doubtful about the fact
that a polling procedure, even with pre-defined rules, will decide about
the level of evidence and therefore recommendations. What makes the
difference: the evidence itself or our belief about it? And then: who
votes and how is he/she mandated by the society? Or by the scientific
community? In this example most authors are again involved in the
guideline committee which was criticized for potential bias in the former
guideline (3, 4). Why should clinicians now believe? Because of a
visualisation tool and polling rules?

1. Jaeschke R, Guyatt GH, Dellinger P, Schünemann H et al. Use of
GRADE grid to reach decisions on clinical practice guidelines when
consensus is elusive. BMJ 2008;337:a744.

2. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM et al. Surviving
Sepsis Campaign: international guidelines for management of severe sepsis
and septic shock: 2008. Crit Care Med 2008;36:296-327.

3. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T et al.
Surviving Sepsis Campaign guidelines for management of severe sepsis and
septic shock. Crit Care Med 2004;32:858-73.

4. Eichacker PQ, Natanson C, Danner RL. Surviving sepsis – practice
guidelines, marketing campaigns, and Eli Lilly. New Engl J Med
006;355:1640-2.

Competing interests:
None declared