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. 2017 Nov 13;20(1):47–56. doi: 10.1007/s12094-017-1765-4

Table 1.

Levels of evidence/grades of recommendation

Levels of evidence
 I Evidence from at least one large randomized, controlled trial of good methodological quality (low potential for bias) or meta-analyses of well-conducted randomized trials without heterogeneity
 II Small randomized trials or large randomized trials with a suspicion of bias (lower methodological quality) or meta-analyses of such trials or of trials with demonstrated heterogeneity
 III Prospective cohort studies
 IV Retrospective cohort studies or case–control studies
 V Studies without control group, case reports, experts opinions
Grades of recommendation
 A Strong evidence for efficacy with a substantial clinical benefit, strongly recommended
 B Strong or moderate evidence for efficacy but with a limited clinical benefit, generally recommended
 C Insufficient evidence for efficacy or benefit does not outweigh the risk or the disadvantages; optional
 D Moderate evidence against efficacy or for adverse outcome, generally not recommended
 E Strong evidence against efficacy or for adverse outcome, never recommended