Translation of Classes of Evidence to Recommendation Levels

In accordance with the strength of evidence for each critical question, the subcommittee drafted the recommendations and supporting text synthesizing the evidence using the following guidelines:

Level A recommendations. Generally accepted principles for patient care that reflect a high degree of scientific certainty (eg, based on evidence from one or more Class of Evidence I or multiple Class of Evidence II studies that demonstrate consistent effects or estimates).

Level B recommendations. Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate scientific certainty (eg, based on evidence from one or more Class of Evidence II studies or multiple Class of Evidence III studies that demonstrate consistent effects or estimates).

Level C recommendations. Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of adequate published literature, based on expert consensus. In instances where consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.

Dr. Valente is an emergency physician and a national committee member of both the ACEP Pediatric Emergency Medicine Committee and ACEP Clinical Policies Committee.