Table 2

Guideline recommendations are classified as either strong or weak by determining the balance of desirable and undesirable outcomes using the GRADE system1

Rating the strength of a recommendation: balancing desirable and undesirable outcomes
Strong recommendationWeak recommendation
Desirable outcomes +++ > undesirable outcomes +Desirable outcomes ++ > undesirable outcomes +
Examples of desirable outcomesExamples of undesirable outcomes

  • Increased longevity

  • Reduction in morbid events intervention designed to prevent

  • Resolution of symptoms

  • Improved quality of life

  • Decreased resource use

  • Decreased longevity

  • Immediate serious complications

  • Short-term relatively minor side effects

  • Long-term rare serious adverse events

  • Impaired quality of life

  • Inconvenience/hassle

  • Increased resource use