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Table 2 Rules for grading the recommendations

From: A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

Strength of recommendation and quality of evidenceBenefit vs. risk and burdensMethodological quality of supporting evidenceaImplications
Strong recommendation, high-quality evidenceBenefits clearly outweigh risk and burdens, or vice versaRCTs without important limitations or overwhelming evidence from observational studiesStrong recommendation, can apply to most patients in most circumstances without reservation
Strong recommendation, moderate quality evidenceBenefits clearly outweigh risk and burdens, or vice versaRCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studiesStrong recommendation, can apply to most patients in most circumstances without reservation
Strong recommendation, low or very low quality evidenceBenefits clearly outweigh risk and burdens, or vice versaObservational studies or case seriesStrong recommendation but may change when higher quality evidence becomes available
Weak recommendation, high-quality evidenceBenefits closely balanced with risks and burdenRCTs without important limitations or overwhelming evidence from observational studiesWeak recommendation, best action may differ depending on circumstances or patients’ or societal values
Weak recommendation, moderate quality evidenceBenefits closely balanced with risks and burdenRCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studiesWeak recommendation, best action may differ depending on circumstances or patients’ or societal values
Weak recommendation, low or very low quality evidenceUncertainty in the estimates of benefits, risks and burden; benefits, risk and burden may be in a closely balancedObservational studies or case seriesVery weak recommendations; other alternatives may be equally reasonable
  1. RCTs randomized controlled trials
  2. aThe evidence agreed on by more than 70% frontline clinicians in consensus meeting is viewed as high-quality evidence