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Injury. 2006 Apr;37(4):321-7. Epub 2006 Feb 20.

Grading the evidence: levels of evidence and grades of recommendation.

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  • 1Division of Orthopaedics, Department of Surgery, McMaster University, Orthopaedic Trauma Service, Hamilton Health Sciences: General Division, Ont., Canada.


Evidence-based medicine is using the best available evidence in order to make accurate and knowledgeable treatment decisions. It is not the automatic gainsay of "low quality" evidence and acceptance of randomized controlled trials (RCT's). To be able to make a sound recommendation for a therapy based on the best available evidence, it is necessary to follow steps in acquiring literature, appraising it for study design and quality, and to assess its results, as well as look at the net benefits and net harms.

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