Evidence levels, recommendation levels
1. Increments of evidence
| Increment | Type | Max. risk of bias |
|---|---|---|
| 1++ | High-quality meta-analyses, systematic reviews of RCTs or RCTs | Very low risk of bias |
| 1+ | Well-conducted meta-analyses, systematic reviews of RCTs or RCTs | Low risk of bias |
| 1 | Meta-analyses, systematic reviews of RCTs or RCTs | High risk of bias |
| 2+ | Well-conducted case-control or cohort studies | Low risk of confounding, bias or chance and at least a medium probability that the association is causal |
| 2 | Case-control or cohort studies | High risk of confounding, bias or chance and at least a significant risk that the association is not causal |
| 3 | Non-analytical studies, e.g. case reports, case series | |
| 4 | Expert opinion |
2. Increments of the recommendation
| Increment | Recommendation |
|---|---|
| A | At least one meta-analysis, systematic review or RCT that has been rated 1++ and is directly applicable to the target population; |
| or a systematic review of RCTs or a body of evidence consisting primarily of studies that are rated 1+, are directly applicable to the target population, and have overall consistency of results | |
| B | A body of evidence that includes studies that are rated 2++, are directly applicable to the target population, and demonstrate overall agreement of results |
| or extrapolated evidence from studies rated 1++ or 1+ | |
| C | Body of evidence includes 2+ rated studies that are directly applicable to the target population and whose results are consistent overall |
| or extrapolated evidence from studies rated 2++ | |
| D | Evidence level 3 or 4 |
| or extrapolated evidence from studies rated 2+ |