Table 1.

Hierarchy of evidence and recommendations grading scheme

Level Type of evidence		Grade Evidence
I	Evidence obtained from one or more randomized controlled trials or a meta-analysis of randomized controlled trials	A	At least one randomized controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation (evidence level I) without extrapolation
IIa	Evidence obtained from at least one well-designed controlled study without randomization	B	Well-conducted clinical studies but no randomized controlled trials on the topic of recommendation (evidence levels II or III); or extrapolated from level I evidence
IIb	Evidence obtained from at least one other well-designed quasi-experimental study
III	Evidence obtained from well-designed nonexperimental descriptive studies, such as comparative studies, correlation studies, and case–control studies
IV	Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities	C	Consensus of expert opinions (evidence level IV) or extrapolated from level I or II evidence. This grading indicates that directly applicable clinical studies of good quality are absent or not readily available

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