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Table 1 Grading recommendations according to the American College of Chest Physicians (ACCP) Task Force

From: Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC)

Grade of Recommendation/Description

Benefit vs Risk and Burdens

Methodological Quality of Supporting Evidence

Implications

1A/strong recommendation, high-quality evidence

Benefits clearly outweigh risk and burdens, or vice versa

RCTs without important limitations or overwhelming evidence from observational studies

Strong recommendation, can apply to most patients in most circumstances without reservation

1B/strong recommendation, moderate quality evidence

Benefits clearly outweigh risk and burdens, or vice versa

RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies

Strong recommendation, can apply to most patients in most circumstances without reservation

1C/strong recommendation, low-quality or very low quality evidence

Benefits clearly outweigh risk and burdens, or vice versa

Observational studies or case series

Strong recommendation but may change when higher quality evidence becomes available

2A/weak recommendation, high quality evidence

Benefits closely balanced with risks and burden

RCTs without important limitations or overwhelming evidence from observational studies

Weak recommendation, best action may differ depending on circumstances or patients’ or societal values

2B/weak recommendation, moderate-quality evidence

Benefits closely balanced with risks and burden

RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies

Weak recommendation, best action may differ depending on circumstances or patients’ or societal values

2C/weak recommendation, low quality or very low-quality evidence

Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced

Observational studies or case series

Very weak recommendations; other alternatives may be equally reasonable

  1. From Baumann MH et al. Chest 2001;119:590–602; RCT indicates randomized controlled trial