Evidence-Based Guideline Development Process
The ACCP Grading System for Guideline Recommendations
Table 1: Relationship of Strength of the Supporting Evidence to the Balance of Benefits to Risks and Burdens
| Balance of Benefits to Risks and Burdens | |||||
|---|---|---|---|---|---|
| Benefits Outweigh Risks/Burdens | Risks/Burdens Outweigh Benefits | Evenly Balanced | Uncertain | ||
| Strength of Evidence | High | 1A | 1A | 2A
|
|
| Moderate
|
1B
|
1B
|
2B
|
||
| Low or Very Low |
1C | 1C | 2C | 2C | |
Table 2: Grade of Recommendations Scale
|
1A
|
Strong recommendation |
|
1B
|
Strong recommendation |
|
1C
|
Strong recommendation |
|
2A
|
Weak recommendation |
|
2B
|
Weak recommendation |
|
2C
|
Weak recommendation |
Table 3: Strength of Evidence Scale
| High | RCTs without important limitations or overwhelming evidence from observational studies |
| Moderate | RCTs with important limitations (inconsistent results, methodologic flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
| Low or Very Low | Observational studies or case series |
Table 4: Balance of Benefits to Risks/Burdens Scale
| Benefits Clearly Outweigh the Risks and Burdens | Certainty of Imbalance |
| Risks and Burdens Clearly Outweigh the Benefits | Certainty of Imbalance |
| The Risks/Burdens and Benefits are Closely Balanced | Less Certainty |
| The Balance of Benefits to Risks and Burdens is Uncertain | Uncertainty |
Guideline Ranking & Disclaimer
Rank | Definition |
|---|---|
| 1 | This guideline is new and represents the best available evidence at this time. It will be reviewed on an annual basis to determine if it remains current. |
| 2 | This guideline is reviewed on an annual basis and there have been new studies published since the guideline was developed. However, the Health and Science Policy (HSP) Committee determined that these studies are not sufficient to warrant changing the guideline at this time. The information contained in this guideline provides the user with the best evidence available at the time the guideline was published. Readers are encouraged to search the current literature as a supplement to using this guideline. |
| 3 | This guideline is reviewed on an annual basis. The HSP Committee determined that new studies have been published that warrant an update of the (fill in) chapter/section of this practice guideline. The HSP Committee also determined that the remainder of the chapters/sections does not require updating and these recommendations remain current. |
| 4 | This guideline is reviewed on an annual basis. The HSP Committee determined that new data are available that are sufficient to potentially change guideline recommendations and a full revision is warranted. |
| 5 | This guideline has been reviewed on an annual basis. The HSP Committee has decided it is outdated; however, it has been retained for historical and/or educational purposes. These guidelines should be used with caution for clinical decision-making purposes. |
The evidence-based practice guidelines published by The American College of Chest Physicians (“ACCP”) incorporate data obtained from a comprehensive literature review of the most recent studies available at the time of publication. Guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any specific condition. Furthermore, guidelines may not be complete or accurate because new studies that may have become available late in the process of guideline development may not be incorporated into any particular guideline before it is disseminated. ACCP and its officers, regents, governors, executive committee, members and employees (the “ACCP Parties”) disclaim all liability for the accuracy or completeness of a guideline, and disclaim all warranties, express or implied. Guideline users always are urged to seek out newer information that might impact the diagnostic and treatment recommendations contained within a guideline. The ACCP Parties further disclaim all liability for any damages whatsoever (including, without limitation, direct, indirect, incidental, punitive, or consequential damages) arising out of the use, inability to use, or the results of use of a guideline, any references used in a guideline, or the materials, information, or procedures contained in a guideline, based on any legal theory whatsoever and whether or not there was advice of the possibility of such damages.
