UpToDate, grading guide. Available at: http://www.uptodate.com/home/grading-guide#GradingRecommendations. Accessed March 8, 2013.
Grade of recommendation | Clarity of risk/benefit | Quality of supporting evidence | Implications |
---|---|---|---|
1A Strong recommendation, high-quality evidence | Benefits clearly outweigh risks and burdens, or vice versa | Consistent evidence from well-performed randomized, controlled trials or overwhelming evidence of some other form; further research is unlikely to change our confidence in estimate of benefit and risks | Strong recommendations, can apply to most patients in most circumstances without reservation; clinicians should follow strong recommendation unless clear and compelling rationale for alternative approach is present |
1B Strong recommendation, moderate-quality evidence | Benefits clearly outweigh risks and burdens, or vice versa | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodological flaws, indirect or imprecise), or very strong evidence of some other research design; further research (if performed) is likely to have impact on our confidence in estimate of benefit and risks and may change estimate | Strong recommendation and applies to most patients; clinicians should follow strong recommendation unless clear and compelling rationale for alternative approach is present |
1C Strong recommendation, low-quality evidence | Benefits appear to outweigh risks and burdens, or vice versa | Evidence from observational studies, unsystematic clinical experience, or randomized, controlled trials with serious flaws; any estimate of effect is uncertain | Strong recommendation, and applies to most patients; some of evidence base supporting recommendation is, however, of low quality |
2A Weak recommendation, high-quality evidence | Benefits closely balanced with risks and burdens | Consistent evidence from well-performed randomized, controlled trials or overwhelming evidence of some other form; further research is unlikely to change our confidence in estimate of benefit and risks | Weak recommendation, best action may differ depending on circumstances or patients or societal values |
2B Weak recommendation, moderate-quality evidence | Benefits closely balanced with risks and burdens; some uncertainly in estimates of benefits, risks, and burdens | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodological flaws, indirect or imprecise), or very strong evidence of some other research design; further research (if performed) is likely to have impact on our confidence in estimate of benefit and risks and may change estimate | Weak recommendation, alternative approaches likely to be better for some patients under some circumstances |
2C Weak recommendation, low-quality evidence | Uncertainty in estimates of benefits, risks, and burdens; benefits may be closely balanced with risks and burdens | Evidence from observational studies, unsystematic clinical experience, or randomized, controlled trials with serious flaws; any estimate of effect is uncertain | Very weak recommendation; other alternatives may be equally reasonable |
Best practice | Recommendation in which either: (i) there is enormous amount of indirect evidence that clearly justifies strong recommendation–direct evidence would be challenging, and inefficient use of time and resources, to bring together and carefully summarize; or (ii) recommendation to contrary would be unethical |
UpToDate, grading guide. Available at: http://www.uptodate.com/home/grading-guide#GradingRecommendations. Accessed March 8, 2013.
UpToDate, grading guide. Available at: http://www.uptodate.com/home/grading-guide#GradingRecommendations. Accessed March 8, 2013.
Quality | Description |
---|---|
High-A | Consistent evidence from well-performed randomized, controlled trials or overwhelming evidence of some other form; further research is unlikely to change our confidence in estimate of benefit and risks |
Moderate-B | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodological flaws, indirect or imprecise), or very strong evidence of some other research design; further research (if performed) is likely to have impact on our confidence in estimate of benefit and risks and may change estimate |
Low-C | Evidence from observational studies, unsystematic clinical experience, or randomized, controlled trials with serious flaws; any estimate of effect is uncertain |
Strength | Description |
---|---|
1. Strong | Benefits clearly outweigh risks and burdens, or vice versa |
2. Weak | Benefits closely balanced with risks and burdens |
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UpToDate, grading guide. Available at: http://www.uptodate.com/home/grading-guide#GradingRecommendations. Accessed March 8, 2013.
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- Fetal blood samplingAmerican Journal of Obstetrics & GynecologyVol. 209Issue 3