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Strength of Recommendation Taxonomy (SORT): A Patient-Centered Approach to Grading Evidence in the Medical Literature

Michigan State University College of Human Medicine, East Lansing (MHE)
Georgetown University Medical Center, Washington, DC (JS)
University of Arizona College of Medicine, Tucson (BDW)
Virginia Commonwealth University School of Medicine, Richmond (SHW)
University of Cincinnati College of Medicine, Cincinnati, Ohio (JS)
University of Chicago, Pritzker School of Medicine, Chicago, Illinois (BE)
University of Pennsylvania Health System, Philadelphia (MAB)

Correspondence: Address correspondence to Mark Ebell, MD, MS, 300 Snapfinger Dr., Athens, GA 30605 (e-mail: ebell{at}msu.edu)

Abstract

A large number of taxonomies are used to rate the quality of an individual study and the strength of a recommendation based on a body of evidence. We have developed a new grading scale that will be used by several family medicine and primary care journals (required or optional), with the goal of allowing readers to learn one taxonomy that will apply to many sources of evidence. Our scale is called the Strength of Recommendation Taxonomy. It addresses the quality, quantity, and consistency of evidence and allows authors to rate individual studies or bodies of evidence. The taxonomy is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. An A-level recommendation is based on consistent and good quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited quality patient-oriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening. Levels of evidence from 1 to 3 for individual studies also are defined. We hope that consistent use of this taxonomy will improve the ability of authors and readers to communicate about the translation of research into practice.

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