Table 3. 2010 American Association of Clinical Endocrinologists Protocol for Production of Clinical Practice Guidelines—Step III: Grading of Recommendations; How Different Evidence Levels can be Mapped to the Same Recommendation Gradea,b.
Best evidence level |
Subjective factor impact |
Two-thirds consensus |
Mapping | Recommendation grade |
---|---|---|---|---|
1 | None | Yes | Direct | A |
2 | Positive | Yes | Adjust up | A |
2 | None | Yes | Direct | B |
1 | Negative | Yes | Adjust down | B |
3 | Positive | Yes | Adjust up | B |
3 | None | Yes | Direct | C |
2 | Negative | Yes | Adjust down | C |
4 | Positive | Yes | Adjust up | C |
4 | None | Yes | Direct | D |
3 | Negative | Yes | Adjust down | D |
1, 2, 3, 4 | NA | No | Adjust down | D |
Starting with the left column, best evidence levels (BELs), subjective factors, and consensus map to recommendation grades in the right column. When subjective factors have little or no impact (“none”), then the BEL is directly mapped to recommendation grades. When subjective factors have a strong impact, then recommendation grades may be adjusted up (“positive” impact) or down (“negative” impact). If a two-thirds consensus cannot be reached, then the recommendation grade is D. NA, not applicable (regardless of the presence or absence of strong subjective factors, the absence of a two-thirds consensus mandates a recommendation grade D).
Reprinted from (1): Endocr Pract. 2010;16:270-283.