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Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations

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Rating the Strength of Evidence From the Comparative Effectiveness Review

The strength of evidence was graded for Key Questions 3 to 5 using the Effective Health Care Program system for grading the strength of evidence. Four domains were assessed including risk of bias, consistency, directness, and precision, and a summary of overall strength of evidence was developed. The grading was done by two independent reviewers, and any discrepancy was resolved by discussion or third-party adjudication, as needed. The risk of bias domain was scored as low, medium, or high risk of bias corresponding to the results of QUADAS (Quality Assessment of Diagnostic Accuracy Studies); the consistency domain was scored as consistent, inconsistent, or unknown based on the visual interpretation of the forest plots; directness was scored as direct or indirect based on the relevance of the evidence to the corresponding question; and precision was scored as precise or imprecise based on the width of 95 percent confidence intervals. The overall summary rating was evaluated as high, moderate, low, or insufficient.