| Grade: 1A |
| Description of recommendation |
| Strong recommendation, high-quality evidence |
| Benefit vs risk and burdens |
| Benefits clearly outweigh risk and burdens, or vice versa |
| Methodologic quality of supporting evidence |
| RCTs without important limitations or overwhelming evidence from observational studies |
| Implications |
| Strong recommendation, can apply to most patients in most circumstances without reservation |
| Grade: 1B |
| Description of recommendation |
| Strong recommendation, moderate quality evidence |
| Benefit vs risk and burdens |
| Benefits clearly outweigh risk and burdens, or vice versa |
| Methodologic quality of supporting evidence |
| RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
| Implications |
| Strong recommendation, can apply to most patients in most circumstances without reservation |
| Grade: 1C |
| Description of recommendation |
| Strong recommendation, low-quality or very low-quality evidence |
| Benefit vs risk and burdens |
| Benefits clearly outweigh risk and burdens, or vice versa |
| Methodologic quality of supporting evidence |
| Observational studies or case series |
| Implications |
| Strong recommendation but may change when higher quality evidence becomes available |
| Grade: 2A |
| Description of recommendation |
| Weak recommendation, high-quality evidence |
| Benefit vs risk and burdens |
| Benefits closely balanced with risks and burden |
| Methodologic quality of supporting evidence |
| RCTs without important limitations or overwhelming evidence from observational studies |
| Implications |
| Weak recommendation, best action may differ depending on circumstances or patients’ or societal values |
| Grade: 2B |
| Description of recommendation |
| Weak recommendation, moderate-quality evidence |
| Benefit vs risk and burdens |
| Benefits closely balanced with risks and burden |
| Methodologic quality of supporting evidence |
| RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
| Implications |
| Weak recommendation, best action may differ depending on circumstances or patients’ or societal values |
| Grade: 2C |
| Description of recommendation |
| Weak recommendation, low-quality or very low-quality evidence |
| Benefit vs risk and burdens |
| Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced |
| Methodologic quality of supporting evidence |
| Observational studies or case series |
| Implications |
| Very weak recommendations; other alternatives may be equally reasonable |
RCT, Randomized controlled trial.
Adapted from Guyatt et al. Used with permission.