. 2014 Oct 30;52(10):993–1004. doi: 10.3109/15563650.2014.973572

Table 3.

Strength of recommendation and level of evidence scaling on clinical outcomes.

Strength of recommendation (consensus-based)	Level of evidence (based on GRADE system)
Level 1 = Strong recommendation = “We recommend…” The course of action is considered appropriate by the majority of experts with no major dissension. The panel is confident that the desirable effects of adherence to the recommendation outweigh the undesirable effectsLevel 2 = Weak recommendation = “We suggest…” The course of action is considered appropriate by the majority of experts, but some degree of dissension exists among the panel members. The desirable effects of adherence to the recommendation probably outweigh the undesirable effectsLevel 3 = Neutral recommendation = “It would be reasonable…” The course of action could be considered appropriate in the right contextNo recommendation No agreement was reached by the group of experts	Grade A=High level of evidence The true effect lies close to our estimate of the effectGrade B=Moderate level of evidence The true effect is likely to be close to our estimate of the effect, but there is a possibility that it is substantially differentGrade C=Low level of evidence The true effect may be substantially different from our estimate of the effectGrade D=Very low level of evidence Our estimate of the effect is just a guess, and it is very likely that the true effect is substantially different from our estimate of the effect

Strength of recommendation (consensus-based)

Level of evidence (based on GRADE system)

Level 1 = Strong recommendation = “We recommend…” The course of action is considered appropriate by the majority of experts with no major dissension. The panel is confident that the desirable effects of adherence to the recommendation outweigh the undesirable effectsLevel 2 = Weak recommendation = “We suggest…” The course of action is considered appropriate by the majority of experts, but some degree of dissension exists among the panel members. The desirable effects of adherence to the recommendation probably outweigh the undesirable effectsLevel 3 = Neutral recommendation = “It would be reasonable…” The course of action could be considered appropriate in the right contextNo recommendation No agreement was reached by the group of experts

Grade A=High level of evidence The true effect lies close to our estimate of the effectGrade B=Moderate level of evidence The true effect is likely to be close to our estimate of the effect, but there is a possibility that it is substantially differentGrade C=Low level of evidence The true effect may be substantially different from our estimate of the effectGrade D=Very low level of evidence Our estimate of the effect is just a guess, and it is very likely that the true effect is substantially different from our estimate of the effect