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level of evidence ratings reflect the strength of the literature that supports a particular clinical or diagnostic testing preference. for each therapy, the level of evidence is further rated as follows:
level a: a systematic review/meta-analysis or randomized controlled trial with a low risk of bias level b: a systematic review/meta-analysis or randomized controlled trial with a moderate risk of bias level c: a systematic review/meta-analysis or randomized controlled trial with a high risk of bias; or a nonrandomized study with a low risk of bias or a single randomized controlled trial with a low risk of bias level d: a systematic review/meta-analysis of observational studies or a systematic review/meta-analysis of randomized controlled trials without pertinent comparison groups level e: expert opinion: for recommendations of diagnosis or therapy based on clinical experience, pathophysiology, pharmacology, or animal data; or an unpublished systematic review
this level of evidence provides a weak recommendation for or against a diagnostic or therapeutic approach. if available, the level of evidence may include a weak recommendation against an approach, a weak recommendation for an approach, or a conditional recommendation. if available, alternative approaches should be considered. an unclassified recommendation indicates that insufficient evidence exists to make a classification, or the evidence is not ranked because the quality is unknown. if insufficient evidence exists, the quality of evidence is unknown or inadequate, or risk of bias is substantial, any grading of evidence should be considered an unclassified recommendation. 3d9ccd7d82