SMART Base
0.3.0 - ci-build

SMART Base, published by WHO. This guide is not an authorized publication; it is the continuous build for version 0.3.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/litlfred/smart-base/ and changes regularly. See the Directory of published versions

CodeSystem: Knowledge graph: GRADE certainty of evidence

Official URL: http://smart.who.int/base/CodeSystem/KGGradeCertainty Version: 0.3.0
Active as of 2026-10-06 Computable Name: KGGradeCertainty

The four levels of certainty GRADE assigns to a BODY of evidence for one outcome — never to a single citation. Randomised trials start at high and observational studies at low, before rating down or up. Moved from smart-kg/methodologies/grade.md by bean wg7r, 2026-09-24 (owner: 'needs to be part of skill/SKOS'). Read with the grade skill. Source: folio-assistant cat-harness/code-lists/grade-certainty.json (bean wg7r), codes and definitions verbatim; Balshem H, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64(4):401-406 https://doi.org/10.1016/j.jclinepi.2010.07.015.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://smart.who.int/base/CodeSystem/KGGradeCertainty defines the following codes:

CodeDisplayDefinition
high High We are very confident that the true effect lies close to the estimate of the effect.
moderate Moderate We are moderately confident in the effect estimate: the true effect is likely to be close to it, but there is a possibility that it is substantially different.
low Low Our confidence in the effect estimate is limited: the true effect may be substantially different from it.
very-low Very low We have very little confidence in the effect estimate: the true effect is likely to be substantially different from it. Not the same finding as 'could not determine' — absent evidence is a gap, not a grade.