Appendix 1 US guideline
| Statement | Definition | Implication |
|---|---|---|
| • Strong recommendation | Anticipated benefits of the recommended intervention clearly exceed the harms (or vice versa if the recommendation is against an intervention) and the quality of the supporting evidence is excellent. In some clearly identified circumstances, when high quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms | Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present |
| • Recommendation | The anticipated benefits exceed the harms, but the quality of evidence is not as strong. In some clearly identified circumstances, when high quality evidence is impossible to obtain but the anticipated benefits outweigh the harms | Clinicians would be prudent to follow a recommendation but should remain alert to new information and sensitive to patient preferences |
| • Option | Courses that may be taken when either the quality of the evidence is suspect or carefully performed studies have shown little clear advantage to one approach over another | Clinicians should consider the option in their decision making, and patient preference may play a substantial role |
| • No recommendation | A lack of pertinent published evidence and the anticipated balance of benefits and harms is unclear | Clinicians should be alert to new published evidence that clarifies the balance of benefit versus harm |