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Grading of recommendations after Guyatt et al. [8] |
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| Grade of recommendation |
Clarity of risk/benefit |
Quality of supporting evidence |
Implications |
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| 1A |
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| Strong recommendation, high-quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa |
Randomised controlled trials (RCTs) without important limitations or overwhelming evidence from observational studies |
Strong recommendations, can apply to most patients in most circumstances without reservation |
| 1B |
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| Strong recommendation, moderate-quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa |
RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
Strong recommendations, can apply to most patients in most circumstances without reservation |
| 1C |
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| Strong recommendation, low-quality or very low-quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa |
Observational studies or case series |
Strong recommendation but may change when higher-quality evidence becomes available |
| 2A |
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| Weak recommendation, high-quality evidence |
Benefits closely balanced with risks and burden |
RCTs without important limitations or overwhelming evidence from observational studies |
Weak recommendation, best action may differ depending on circumstances or patients' or societal values |
| 2B |
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| Weak recommendation, moderate-quality evidence |
Benefits closely balanced with risks and burden |
RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
Weak recommendation, best action may differ depending on circumstances or patients' or societal values |
| 2C |
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| Weak recommendation, low-quality or very low-quality evidence |
Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced |
Observational studies or case series |
Very weak recommendation, other alternatives may be equally reasonable |
Spahn et al. Critical Care 2007 11:R17 doi:10.1186/cc5686 |
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