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. 2024 Jul 13;24(1):787.
doi: 10.1186/s12903-024-04542-w.

Pediatric dentistry systematic reviews using the GRADE approach: methodological study

Rachel Alvarenga-Brant  1 , Sarah Queiroz Notaro  2 , Cristine Miron Stefani  3 , Graziela De Luca Canto  4 , Alexandre Godinho Pereira  1 , Luciana Póvoa-Santos  2 , Ana Clara Souza-Oliveira  2 , Julya Ribeiro Campos  1 , Carolina Castro Martins-Pfeifer  5
Affiliations

Pediatric dentistry systematic reviews using the GRADE approach: methodological study

Rachel Alvarenga-Brant et al. BMC Oral Health. .

Abstract

Background: To assess the reporting of the certainty of the evidence using the GRADE approach in systematic reviews of interventions in pediatric dentistry.

Methods: The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in pediatric dentistry that reported the certainty of the evidence through the GRADE approach. Paired independent reviewers screened the studies, extracted data, and appraised the methodological quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. The certainty of the evidence was extracted for each outcome. A descriptive analysis was conducted.

Results: Around 28% of pediatric dentistry reviews of interventions used the GRADE approach (n = 24). Twenty reviews reported 112 evidence outcomes from RCTs and 13 from NRSIs using GRADE evidence profile tables. The methodological quality was high (16.7%), moderate (12.5%), low (37.5%), and critically low (33.3%), fulfilling the majority of the AMSTAR 2 criteria. The certainty of the evidence for outcomes generated from RCTs and NRSIs was very low (40.2% and 84.6%), low (33.1% and 7.7%), moderate (17.8% and 7.7%), and high (9.8% and 0.0%). The main reasons to downgrade the certainty were due to (for RCTs and NRSIs, respectively): risk of bias (68.8% and 84.6%), imprecision (67.8% and 100.0%), inconsistency (18.8% and 23.1%), indirectness (17.8% and 0.0%), and publication bias (7.1% and 0.0%).

Conclusion: The proportion of systematic reviews assessing the certainty of the evidence using the GRADE approach was considered small, considering the total initial number of published pediatric dentistry reviews of intervention. The certainty of the evidence was mainly very low and low, and the main problems for downgrading the certainty of evidence were due to risk of bias and imprecision.

Registration: PROSPERO database #CRD42022365443.

Keywords: Child; Clinical trial; Dental care; Meta-analysis; Oral health; Overview, GRADE approach; Pediatric dentistry; Systematic review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

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Fig. 1
PRISMA flowchart showing the screening process
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