Rationale: Methodological quality of systematic reviews (SRs) remains an area of concern with no consensus on the optimal appraisal instrument to assess quality of published research. Hypothesis: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a feasible and useful methodology to assess quality of evidence in pediatric pharmacotherapy. Aim: To demonstrate the applicability of the GRADE to selected topics. Methods: To perform two SRs to illustrate the practical use of the GRADE, highlight methodological challenges encountered and compare the GRADE to the alternative appraisal tool. Results: the GRADE was implemented to conduct two SRs. Judgments on imprecision were challenging. Comparison of the GRADE to alternative tool demonstrated that GRADE may generate different conclusions on overall quality assessment. Conclusion: The GRADE is a valuable innovative tool for assessing quality of evidence, applicable to the field of pediatric pharmacotherapy, with a potential to impact inferences drawn after applying alternative instruments.

Rationale: Methodological quality of systematic reviews (SRs) remains an area of concern with no consensus on the optimal appraisal instrument to assess quality of published research. Hypothesis: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a feasible and useful methodology to assess quality of evidence in pediatric pharmacotherapy. Aim: To demonstrate the applicability of the GRADE to selected topics. Methods: To perform two SRs to illustrate the practical use of the GRADE, highlight methodological challenges encountered and compare the GRADE to the alternative appraisal tool. Results: the GRADE was implemented to conduct two SRs. Judgments on imprecision were challenging. Comparison of the GRADE to alternative tool demonstrated that GRADE may generate different conclusions on overall quality assessment. Conclusion: The GRADE is a valuable innovative tool for assessing quality of evidence, applicable to the field of pediatric pharmacotherapy, with a potential to impact inferences drawn after applying alternative instruments.