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 |