GRADE Working Group grades of evidence
High certainty:ย We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty:ย We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty:ย Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty:ย We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
Explanations:
a. Galan 2021 [14]; Gonzalez 2021 [15]; Lopez Medina 2021 [16]; Mohan 2021 [17]; Niaee et al 2021 [18]; Ravikirti 2021 [20]
b. Downgraded by one level for serious risk of bias. Due to Galan 2021 [14] and Niaee 2021 [18] having high risk of bias, and Gonzalez 2021 [15] and Ravikirti [20] having some concerns for risk of bias.
c. Downgraded by one level for serious inconsistency. There was substantial heterogeneity (I-squared=62%), and visually some trials have point effect estimates very far from others.
d. Downgraded by two levels for very serious imprecision, due to small absolute number of events, and CIs include important potential benefit and important potential harm.
e. Galan 2021 [14]; Mohan 2021 [17]; Pott-Junior 2021 [19]; Ravikirti 2021 [20].
f. Downgraded by one level for serious risk of bias, due to Pott-Junior 2021 [19] having high risk of bias, and Galan 2021 [14] and Ravikirti 2021 [20] having some concerns for risk of bias.
g. Downgraded by one level for serious inconsistency, due to substantial heterogeneity (I-squared=48%) and visually some trials having point effect estimates very far from each other.
h. Downgraded by two levels for very serious imprecision, due to small absolute number of events, and CIs including important potential benefit and important potential harm.
i. Ahmed 2020 [9]; Bukhari 2021 [11]; Chaccour 2021 [12]; Mohan 2021 [17]; Pott-Junior 2021 [19]; Ravikirti 2021 [20]
j. Downgraded by two levels for very serious risk of bias, due to Ahmed 2020 [9], Bukhari 2021 [11] and Pott-Junior 2021 [19] having high risk of bias for this outcome.
k. Downgraded by one level for serious inconsistency, due to substantial heterogeneity (I-squared=70%) and visually some trials having point effect estimates very far from those of other trials.
l. Downgraded by one level for serious imprecision, due to CIs overlapping no effect and inability to exclude important benefit.
m. Chaccour 2021 [12]; Chachar 2021 [13]; Lopez Medina 2021 [16]; Mohan 2021 [17]; Pott-Junior 2021 [19]
n. Downgraded by one level for serious risk of bias., due to Chaccour 2021 [12], Chachar 2021 [13] and Pott-Junior 2021 [19] having high risk of bias. Lopez-Medina 2021 [16] contributes 53% weight to the meta-analysis was at low risk of bias.
o. Downgraded by two levels for very serious imprecision, due to CIs overlapping including important potential benefit and important potential harm.
p. Gonzalez 2021 [15]; Lopez Medina 2021 [16]; Mohan 2021 [17].
q. Downgraded by one level for serious risk of bias, due to Gonzalez having high risk of bias.
r. Downgraded by two levels for very serious imprecision, due to CIs including important potential benefit and important potential harm.