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Recommendation Rating Scale
Strong
Recommendation
(S)
A Strong Recommendation
means the benefits of the
recommended approach clearly
exceed the harms (or that the
harms clearly exceed the benefits
in the case of a strong negative
recommendation) and that
the quality of the supporting
evidence is excellent (Grade A
or B)
Clinicians should follow a
Strong Recommendation
unless a clear and compelling
rationale for an alternative
approach is present.
Recommendation
(R)
A Recommendation means the
benefits exceed the harms (or
that the harms clearly exceed
the benefits in the case of a
negative recommendation), but
the quality of evidence is not as
strong (Grade B or C).
Clinicians should
also generally follow a
recommendation but
should remain alert to new
information and sensitive to
patient preferences.
Option (O)
An option means that, either
well-done studies (Grade A, B,
or C) show little clear advantage
to one approach versus another,
or that the quality of evidence
that exists is suspect (Grade D).
Clinicians should be flexible
in their decision making
regarding appropriate practice,
although they may set bounds
on alternatives; patient
preference should have a
substantial influencing role.
No
recommendation
(N)
No recommendation means
there is both a lack of pertinent
evidence (Grade D) and an
unclear balance between benefits
and harms.
Clinicians should feel little
constraint in their decision
making and be alert to new
published evidence that
clarifies the balance of benefit
versus harm; patient preference
should have a substantial
influencing role.
