27
AAP Defined Strategy for Recommendation Development
Evidence Quality
Preponderance
of Benefit over
Harm
Balance of
Benefit and
Harm
Preponderance
of Harm over
Benefit
A. Well-designed RCTs Strong
Recommendation
Option Strong
Recommendation
Against
B. RCTs with minor
limitations;
Overwhelmingly
consistent evidence
from observational
studies
Recommendation
C. Observational studies
(case control and
cohort design)
D. Expert opinion,
Case reports,
Reasoning from first
principles
Option No
Recommendation
Recommendation
Against
