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Health and Science Policy and Evidence-Based Medicine

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