Strength of Recommendation and Quality of Evidence
Category/Grade
Strength of
Recommendation
A
B
C
Quality of
Evidence
I
II
III
Definition
Good evidence to support a recommendation for use
Moderate evidence to support a recommendation for use
Poor evidence to support a recommendation
Evidence from ≥1 properly randomized, controlled trial
Evidence from ≥1 well-designed clinical trial without
randomization, from cohort or case-controlled analytic studies
(preferably from >1 center), from multiple time-series, or from
dramatic results from uncontrolled experiments
Evidence from opinions of respected authorities based on clinical
experience, descriptive studies, or reports of expert committees
Source: Canadian Task Force on the Periodic Health Examination. Can Med Assoc J.
1979;121:1193-1254.
Sources
Centers for Disease Control and Prevention. Prevention and control of seasonal influenza
with vaccines: recommendations of the Advisory Committee of Immunization Practices –
United States, 2013-2014. MMWR Recomm Rep. 2013;62:1-43.
Harper SA, Bradley JS, Englund JA, et al. Seasonal influenza in adults and children –
diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical
practice guidelines of the Infectious Diseases Society of America (IDSA). Clin Infect Dis.
2009;48:1003-1032.
Disclaimer
This Guideline attempts to define principles of practice that should produce high-quality patient
care. It is applicable to specialists, primary care, and 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 after 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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