American Academy of Pediatrics

TABLE 2

Grading of Recommendations Assessment, Development and Evaluation (GRADE) System^14,–,18

1. Classification of evidence

Grade

A. High

Further research is very unlikely to change our confidence in the estimate of effect

B. Moderate

Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate

C. Low

Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate

D. Very low

Any estimate of effect is very uncertain

2. Recommendations: The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh undesirable effects.

Strong

When the desirable effects of an intervention clearly outweigh the undesirable effects, or clearly do not.

For patients—most people in your situation would want the recommended course of action and only a small proportion would not
For clinicians—most patients should receive the recommended course of action
For policy makers—the recommendation can be adopted as a policy in most situations

Weak

Evidence suggests that desirable and undesirable effects are closely balanced or the quality of evidence is low.

For patients—most people in your situation would want the recommended course of action, but many would not
For clinicians—you should recognize that different choices will be appropriate for different patients and you must help each patient to arrive at a management decision consistent with his or her values and preferences.
For policy makers—policy making will require substantial debate and involvement of many stakeholders

No specific recommendations

The advantages and disadvantages of the recommendations are equivalent or where there is insufficient evidence on which to formulate a recommendation

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