Table 12. Class of Recommendations and
Level of Evidence (2015 Update)
a
CLASS (STRENGTH) OF RECOMMENDATION
CLASS I (STRONG) Benefit >>> Risk
Suggested phrases for writing recommendations:
◼ Is recommended
◼ Is indicated/useful/effective/beneficial
◼ Should be performed/administered/other
◼ Comparative-Effectiveness Phrases
b
:
◦ Treatment/strategy A is recommended/indicated in preference to
treatment B
◦ Treatment A should be chosen over treatment B
CLASS IIa (MODERATE) Benefit >> Risk
Suggested phrases for writing recommendations:
◼ Is reasonable
◼ Can be useful/effective/beneficial
◼ Comparative-Effectiveness Phrases
b
:
◦ Treatment/strategy A is probably recommended/indicated in preference to
treatment B
◦ It is reasonable to choose treatment A over treatment B
CLASS IIb (WEAK) Benefit ≥ Risk
Suggested phrases for writing recommendations:
◼ May/might be reasonable
◼ May/might be considered
◼ Usefulness/effectiveness is unknown/unclear/uncertain or not well established
CLASS III: No Benefit (MODERATE)
(Generally, LOE A or B use only)
Benefit = Risk
Suggested phrases for writing recommendations:
◼ Is not recommended
◼ Is not indicated/useful/effective/beneficial
◼ Should not be performed/administered/other
CLASS III: Harm (STRONG) Risk > Benefit
Suggested phrases for writing recommendations:
◼ Potentially harmful
◼ Causes harm
◼ Associated with excess morbidity/mortality
◼ Should not be performed/administered/other
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