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. Author manuscript; available in PMC: 2016 Jul 25.
Published in final edited form as: Endocr Pract. 2015 Apr;21(Suppl 1):1–87. doi: 10.4158/EP15672.GL

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
a

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).

b

Reprinted from (1): Endocr Pract. 2010;16:270-283.