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Table 1 Grades of Recommendations according to the American College of Chest Physicians (ACCP) 78

From: Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society

Grade of recommendation

Clarity of risk/benefit

Methodological strength of supporting evidence

Implications

1A

Risk/benefit clear

Randomized controlled trials (RCTs) without important limitations

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

1 B

Risk/benefit clear

RCTs with important limitations (inconsistent results, methodological flaws)

Strong recommendations, likely to apply to most patients

1 C+

Risk/benefit clear

No RCTs but RCT results can be unequivocally extrapolated, or overwhelming evidence from observational studies

Strong recommendation, can apply to most patients in most circumstances

1 C

Risk/benefit clear

Observational studies

Intermediate strength recommendation; may change when stronger evidence available

2A

Risk/benefit unclear

RCTs without important limitations

Intermediate strength recommendation, best action may differ depending on circumstances or patients' or societal values

2 B

Risk/benefit unclear

RCTs with important limitations (inconsistent results, methodological flaws)

Weak recommendation, alternative approaches likely to be better for some patients under some circumstances

2 C

Risk/benefit unclear

Observational studies

Very weak recommendations; other alternatives may be equally reasonable