Grading System for Recommendations Category of Evidence
Ia Ib
Evidence from meta-analysis of randomized controlled trials
Evidence from at least one randomized controlled trial
IIa Evidence from at least one controlled study without
randomization
IIb Evidence from at least one other type of quasiexperimental study
III Evidence from nonexperimental descriptive studies, such as
comparative studies
IV Evidence from expert committee reports or opinions or clinical
experience of respected authorities or both
C Directly based on category III evidence or extrapolated recommendation from
category I or II evidence
D Directly based on category IV evidence or extrapolated recommendation from
category I, II, or III evidence
B Directly based on category II evidence or extrapolated recommendation from
category I evidence
Strength of Recommendation A Directly based on category I evidence
Abbreviations DT, diphtheria and tetanus toxoids (pediatric formulation); DTaP, diphtheria and tetanus toxoids and acellular pertussis (pediatric formulation); Hib, Haemophilus influenzae type B; HPV, human papillomavirus; MMRV, measles, mumps, rubella and varicella; Td, tetanus and diphtheria toxoids (adult/ adolescent formulation); Tdap, tetanus and diphtheria toxoids and acellular pertussis (adult/adolescent formulation)
Source Kelso JM, Li JT, Nicklas RA, et al. Adverse reactions to vaccines. Ann Allergy Asthma Immunol. 2009;103(4 Suppl 2):S1-S14.
Disclaimer
This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.
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