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Table 1 Grading of recommendations after Guyatt et al. [8]

From: Management of bleeding following major trauma: a European guideline

Grade of recommendation

Clarity of risk/benefit

Quality of supporting evidence

Implications

1A

   

Strong recommendation, high-quality evidence

Benefits clearly outweigh risk and burdens, or vice versa

Randomised controlled trials (RCTs) without important limitations or overwhelming evidence from observational studies

Strong recommendations, can apply to most patients in most circumstances without reservation

1B

   

Strong recommendation, moderate-quality evidence

Benefits clearly outweigh risk and burdens, or vice versa

RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies

Strong recommendations, can apply to most patients in most circumstances without reservation

1C

   

Strong recommendation, low-quality or very low-quality evidence

Benefits clearly outweigh risk and burdens, or vice versa

Observational studies or case series

Strong recommendation but may change when higher-quality evidence becomes available

2A

   

Weak recommendation, high-quality evidence

Benefits closely balanced with risks and burden

RCTs without important limitations or overwhelming evidence from observational studies

Weak recommendation, best action may differ depending on circumstances or patients' or societal values

2B

   

Weak recommendation, moderate-quality evidence

Benefits closely balanced with risks and burden

RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies

Weak recommendation, best action may differ depending on circumstances or patients' or societal values

2C

   

Weak recommendation, low-quality or very low-quality evidence

Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced

Observational studies or case series

Very weak recommendation, other alternatives may be equally reasonable