Integrating evidence quality appraisal with an assessment of the anticipated balance between benefits and harms if a policy is carried out leads to designation of a policy as a strong recommendation, recommendation, option, or no recommendation.
Oxyhemoglobin dissociation curve showing percent saturation of hemoglobin at various partial pressures of oxygen. Note that the position of the curve and the affinity of hemoglobin for oxygen changes with changing physiologic conditions. (Reproduced with permission from the educational website www.anaesthesiauk.com.)
Guideline Definitions for Evidence-Based Statements
A strong recommendation in favor of a particular action is made when the anticipated benefits of the recommended intervention clearly exceed the harms (as a strong recommendation against an action is made when the anticipated harms clearly exceed the benefits) and the quality of the supporting evidence is excellent. In some clearly identified circumstances, strong recommendations may be made 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.
A recommendation in favor of a particular action is made when the anticipated benefits exceed the harms but the quality of evidence is not as strong. Again, in some clearly identified circumstances, recommendations may be made 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.
Options define courses that may be taken when either the quality of 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 have a substantial role.
No recommendation indicates that there is a lack of pertinent published evidence and that the anticipated balance of benefits and harms is presently unclear.
Clinicians should be alert to new published evidence that clarifies the balance of benefit versus harm.