Clinical guidelines are the backbone of evidence-based medicine.

Clinical Guidelines: Let’s explain the evidence levels and recommendation grades.

Clinical guidelines – systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The panel of experts develops such guidelines using standardised methods.

The clinical guidelines group does not intend for recommendations to dictate an exclusive course of management or treatment. Clinicians must evaluate them regarding individual patient needs, resources, and limitations unique to the health care setting and variations in local populations.

In formulating clinical guidelines, the expert panel draws attention to areas of clinical uncertainty that may require further research.

We classify evidence levels as:

1++ High-quality meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with very minimal risk of bias.

1+ Here, they review well-conducted meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a low risk of bias.

1- They review meta-analyses, systematic reviews of randomised controlled trials or randomised controlled trials with a high risk of bias.

2++ The panel reviews the high-quality systematic reviews of case-control or cohort studies or high-quality case-control or cohorts with very minimal risk of confounding, bias or chance and a high probability that the relationship is causal.

2+ They look at well-conducted case-control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal.

2- Case-control or cohort studies with a high risk of confounding, a bias of chance and significant risk of that the relationship is not causal.

3 Non-analytical studies such as case reports, case series.

4 Expert opinion

We grade recommendations is as A, B, C, or D in descending order of strength. We explain this further.

A  At least one meta-analysis, systematic review, or randomised controlled trial rated as 1++, and directly applicable to the target population; or a systematic review of randomised controlled trials or body of evidence consisting principally of studies rated as 1+, directly relevant to the target population and demonstrating overall consistency of results.

B A body of evidence including studies rated as 2++ directly applicable to target population, and demonstrating overall consistency of results: or extrapolated evidence from studies rated as 1++ or 1+.

C This entails a body of evidence including studies rated as 2+ directly relevant to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++.

D Evidence level 3 or 4; or extrapolated evidence from studies rated as 2+.

We regard a few recommendations as good practice points – based on the clinical experience of the expert panel developing the guidelines.

It is paramount that health care workers understand these levels of evidence and grades of recommendation to enable them to apply the guidelines appropriately in their clinical settings. Read more about how the experts formulate the clinical guidelines here.

Your CPD points are just a click away, read this article to know more.

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