Table 2.
Grading of recommendations (from Guyatt et al.)
| Grade of recommendation | Description | Benefits vs. risks | Quality of supporting evidence | Implications |
|---|---|---|---|---|
| 1A | Strong recommendation, high-quality evidence | Benefits clearly outweigh risks and burdens, or vice versa | RCTs without important limitations or overwhelming evidence from observational studies | Strong recommendation, applies to most patients in most circumstances without reservation |
| 1B | Strong recommendation, moderate-quality evidence | Benefits clearly outweigh risk and burdens, or vice versa | RCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studies | Strong recommendation, applies to most patients in most circumstances without reservation |
| 1C | Strong recommendation, low-quality or very low-quality evidence | Benefits clearly outweigh risk and burdens, or vice versa | Observational studies or case series | Strong recommendation based on limited evidence; recommendations may change when higher quality or more extensive evidence becomes available |
| 2A | Weak recommendation, high-quality evidence | Benefits closely balanced with risks and burdens | RCTs without important limitations or overwhelming evidence from observational studies | Weak recommendation; best action may differ depending on circumstances, expertise of clinician, the patient in question, or other social issues |
| 2B | Weak recommendation, moderate-quality evidence | Benefits closely balanced with risks and burdens | RCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studies | Weak recommendation; best action may differ depending on circumstances, expertise of clinician, the patient in question, or other social issues |
| 2C | Weak recommendation, low-quality or very low quality evidence | Uncertainty in the estimates of benefits, risks, and burdens; benefits, risks, and burdens may be closely balanced | Observational studies or case series | Very weak recommendation; other alternatives may be equally reasonable |