Table 2.

What the grades of evidence mean and suggestions for practice

Grade	Definition	Suggestions for practice
A	Our committee recommends this treatment, test or strategy to improve outcomes. There is high certainty that the net benefit is substantial.	Offer or provide this service.
B	Our committee recommends this treatment, test or strategy to improve outcomes. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.	Offer or provide this service.
C	Our committee recommends selectively offering or providing this treatment, test or strategy to improve outcomes to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.	Offer or provide this service for selected patients depending on individual circumstances.
D	Our committee recommends against the intervention. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.	Discourage the use of this service.
I Statement	Our committee concludes that the current evidence is insufficient to assess the balance of benefits and harms of the intervention. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.	Read the clinical considerations section of the Recommendation Statement. If the treatment or service is offered, patients should understand the uncertainty about the balance of benefits and harms.