Grades and Levels of Evidence: Difference between revisions
Rachael Lowe (talk | contribs) m (moved Grades & Levels of Evidence to Grades and Levels of Evidence) |
Rachael Lowe (talk | contribs) No edit summary |
||
Line 95: | Line 95: | ||
|} | |} | ||
Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes, Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.<br> | Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes, Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.<br> | ||
[http://www.cebm.net/index.aspx?o=4590 Download a pdf of this chart here.] | [http://www.cebm.net/index.aspx?o=4590 Download a pdf of this chart here.] | ||
Line 139: | Line 139: | ||
[http://www.cebm.net/ Oxford Center for Evidence Based Medicine] | [http://www.cebm.net/ Oxford Center for Evidence Based Medicine] | ||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
<rss>http:// | <div class="researchbox"> | ||
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=10SuWQ8ymABeukSieeKZKAtlGHdCpV9HrIUew2NBKz3B0QVQAs|charset=UTF-8|short|max=10</rss> </div> | |||
<br> <br> | <br> <br> | ||
Revision as of 08:50, 24 March 2015
Original Editor - Tyler Shultz
Top Contributors - Tyler Shultz, Rachael Lowe, Admin, Scott Buxton, WikiSysop and Amanda Ager
Discussion & Background[1][edit | edit source]
What are we to do when the irresistible force of the need to offer clinical advice meets with the immovable object of flawed evidence? All we can do is our best: give the advice, but alert the advisees to the flaws in the evidence on which it is based.
The CEBM 'Levels of Evidence' guidelines set out one approach to systematizing this process for different question types.
Levels of Evidence[1]
[edit | edit source]
Level |
Therapy/Prevetion, Aetiology/Harm |
Prognosis |
Diagnosis |
Differential Diagnosis |
Economic and Descision Analysis |
1A |
SR (with homogeneity) of RCTs |
SR (with homogeneity) of inception cohort studies; CDR validated in different populations |
SR (with homogeneity) of Level 1 diagnostic studies; CDR with 1b studies from different clinical centres |
SR (with homogeneity) of prospective cohort studies |
SR (with homogeneity) of Level 1 economic studies |
1B |
Individual RCT (with narrow Confidence Interval) |
Individual inception cohort study with > 80% follow-up; CDR validated in a single population |
Validating cohort study with good reference standards; or CDR tested within one clinical centre |
Prospective cohort study with good follow-up |
Analysis based on clinically sensible costs or alternatives; systematic review(s) of the evidence; and including multi-way sensitivity analyses |
1C |
All or none series |
All or none case serires |
Absoulute SpPins and SnNouts |
All or none case series |
Absolute better-value or worse-value analyses |
2A |
SR (with homogeneity) of cohort studies |
SR (with homogeneity) of either retrospective cohort studies or untreated control groups in RCTs |
SR (with homogeneity) of Level >2 diagnostic studies |
SR (with homogeneity) of 2b and better studies |
SR (with homogeneity) of Level >2 economic studies |
2B |
Individual cohort study (including low quality RCT; e.g., <80% follow-up) |
Retrospective cohort study or follow-up of untreated control patients in an RCT; Derivation of CDR or validated on split-sample only |
Exploratory cohort study with good reference standards; CDR after derivation, or validated only on split-sample or databases |
Retrospective cohort study, or poor follow-up |
Analysis based on clinically sensible costs or alternatives; limited review(s) of the evidence, or single studies; and including multi-way sensitivity analyses |
2C |
"Outcomes" Research; Ecological studies |
"Outcomes" Research |
Etiological Studies |
Audit or outcomes research | |
3A |
SR (with homogeneity) of case-control studies |
SR (with homogeneity) of 3b and better studies |
SR (with homogeneity) of 3b and better studies |
SR (with homogeneity) of 3b and better studies | |
3B |
Individual Case-Control Study |
Non-consecutive study; or without consistently applied reference standards |
Non-consecutive cohort study, or very limited population |
Analysis based on limited alternatives or costs, poor quality estimates of data, but including sensitivity analyses incorporating clinically sensible variations. | |
4 |
Case-series (and poor quality cohort and case-control studies) |
Case-series (and poor quality prognostic cohort studies) |
Case-control study, poor or non-independent reference standard |
Case-series or superseded reference standards |
Analysis with no sensitivity analysis |
5 |
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" |
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" |
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" |
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" |
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" |
Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes, Martin Dawes since November 1998. Updated by Jeremy Howick March 2009.
Download a pdf of this chart here.
Grades of Evidence[2][edit | edit source]
Grades of Recommendation | Strength of Evidence | |
A | Strong Evidence | A prepoderance of level I and/or level II studies support the recommendation. This must include at least 1 level I study. |
B | Moderate Evidence | A single high-quality randomized controlled trial or a preponderance of level II studies support the recommendation |
C | Weak Evidence | A single level II study or a preponderance of level III and IV studies including statements of consensus by content experts support the recommendation |
D | Conflicting Evidence | Higher-quality studies conducted on this topic disagree with respect to thier conclusions. The recommendation is based on these conflicting studies |
E | Theoretical/ Foundational Evidence | A preponderance of evidence from animal or cadaver studies, from conceptual models/principles, or from basic sciences/bench research support this conclusion |
F | Expert Opinion | Best practice based on the clinical experience of the guidelines development team |
Resources[edit | edit source]
Oxford Center for Evidence Based Medicine
Recent Related Research (from Pubmed)[edit | edit source]
Read 4 Credit[edit | edit source]
Would you like to earn certification to prove your knowledge on this topic? All you need to do is pass the quiz relating to this page in the Physiopedia member area.
|
References
[edit | edit source]
- ↑ 1.0 1.1 Levels of Evidence. 2009. Available at: http://www.cebm.net/index.aspx?o=1025 [Accessed June 8, 2009].
- ↑ Guyatt GH, Sackett DL, Sinclair JC, et al. Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA. 1995;274(22):1800-1804.