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Table 1 GRADE system for rating quality of evidence and strength of recommendation [41]

From: Scandinavian guidelines for initial management of minor and moderate head trauma in children

Factor

Description

Evidence

 High quality

Considerate confidence of the estimate effect. Further research is very unlikely to change our confidence in the estimated effect.

 Moderate quality

Confidence that the estimate is close to the truth. Further research is likely to have an important impact on our confidence in the estimate effect and may change the estimate.

 Low quality

Limited confidence in the effect. Further research is likely to have an important impact on our confidence in the estimate effect and is likely to change the estimate.

 Very low quality

Little confidence in the effect estimate. Any change of effect is uncertain.

Recommendation

 Strong: “We recommend…”

A strong recommendation indicates that most well-informed people will make the same choice.

 Weak: “We suggest…”

A weak recommendation indicates that the majority of well-informed people will make the same choice but a substantial minority will not

 Uncertain: “We cannot recommend…”

No specific recommendation for or against

  1. Factors influencing the strength of the recommendation include quality of evidence, risk/benefit aspects of presumed patient-important outcomes, costs and uncertainty concerning values and preferences
  2. GRADE Grading of Recommendations Assessment, Development and Evaluation