TABLE 1

Guideline Definitions for Evidence-Based Statements

StatementDefinitionImplication
Strong recommendationA particular action is favored because anticipated benefits clearly exceed harms (or vice versa), and quality of evidence is excellent or unobtainable.Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
Moderate recommendationA particular action is favored because anticipated benefits clearly exceed harms (or vice versa), and the quality of evidence is good but not excellent (or is unobtainable).Clinicians would be prudent to follow a moderate recommendation but should remain alert to new information and sensitive to patient preferences.
Weak recommendation (based on low-quality evidenceA particular action is favored because anticipated benefits clearly exceed harms (or vice versa), but the quality of evidence is weak.Clinicians would be prudent to follow a weak recommendation but should remain alert to new information and very sensitive to patient preferences.
Weak recommendation (based on balance of benefits and harms)Weak recommendation is provided when the aggregate database shows evidence of both benefit and harm that appear similar in magnitude for any available courses of actionClinicians should consider the options in their decision making, but patient preference may have a substantial role.