Rosetta Stone for Comparing Levels or Grades of Evidence in Various Healthcare Professions revised 11/9/10, Š Dr. Chris E. Stout General Medicine Strongly recommend
Arthroscopic Surgery Level I RCT Systematic review of Level I RCTs Prospective study
Recommended
Level II Prospective Cohort Retrospective study
Medical Profession Orthopedic Medicine Recommendations Grade A, Grade A – Good Evidence level Ia Evidence, Level and Ib 1,or Treatment Recommendation Standard based on at least Recommendations one randomized for or against that controlled trial of are supported by good quality and consistent consistency incontrovertible addressing evidence. May be specific recommended recommendation with great confidence Grade B: Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention. AHRQ
Systematic review of Level I – II studies
Behavioral Health
Pain medicine
Recommend for Practice Interventions for which effectiveness has been demonstrated by strength/quality of evidence.
Evidence based
Level I Conclusive: Research-based evidence with multiple relevant and high-quality scientific studies or consistent reviews of metaanalyses.
Benefits > risks
Likely to Be Effective Interventions for which evidence is less well established than those above
Promising Practice
Level II Strong: Research-based evidence from at least 1 properly designed randomized, controlled trial; or researchbased evidence from multiple properly designed studies of smaller size; or multiple low quality trials.
Level III Moderate: a) Evidence obtained from well-designed pseudo randomized controlled trials (alternate allocation or some other method); b) evidence obtained from
.
Poor quality RCT Nonhomogeneous Level I studies
Weak Recommendation
Level III Case-control Retrospective cohort Systematic review of Level III
Grade B, Evidence levels IIa, IIb, and III Recommendation based on wellconducted studies but no randomized controlled trials on the topic of recommendation
Risk/burden vs. Benefit
Oncology Nursing
Benefits Balanced with Harms = Interventions for which clinicians and patients should weigh the effects r/t to circumstances and priorities.
Type of Evidence
Implications
Systematic Reviews
Can apply to most patients
Benefits > risks
RCT with limitations, case series, observation studies
Can apply to most patients, but may change with newer information.
Benefits balance the risks/burdens
Limited evidence or inconsistent evidence
Action depends on circumstance and patient preference
Harm is small compared to the benefits.
Neither recommended nor condemned
Level IV No control group or case-control study Poor reference standard
Grade C, Evidence level IV Evidence from expert committee reports and/or clinical experiences of respected authorities
Grade C or Treatment Option Recommendations supported by poor quality or controversial evidence (Level IV or V studies)
Effectiveness not established = Insufficient or inadequate data quality currently exist
Experimental
Grade I: Insufficient or conflicting evidence not allowing a recommendation for or against intervention
Not recommended for practice = Clear evidence for harm or ineffectiveness.
Unsupported
No sensitivity analyses
Not recommended
Level V Expert opinion
comparative studies with concurrent controls and allocation not randomized (cohort studies, case-controlled studies, or interrupted time series with a control group); c) evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group Level IV Limited: Evidence from well-designed nonexperimental studies from more than 1 center or research group; or conflicting evidence with inconsistent findings in multiple trials. Level V Indeterminate: Opinions of respected authorities, based on clinical evidence, descriptive studies, or reports of expert committees
Uncertainty of risks, benefits or burdens
Observational or case series
Other alternatives may be equally reasonable