ESA guidelines classification scheme

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The Class designation is used to indicate whether a therapy is recommended or not and the certainty surrounding that recommendation. The Level of Evidence designation is used to indicate the strength of the data associated with that recommendation.

Classification of Recommendations

Class 1: Benefit >>> Risk

Benefits clearly outweigh risk and burdens, or vice versa.

Class 2: Benefit ≈ Risk

Class 2A

Benefits closely balanced with risks and burdens.

Class 2B

Benefits closely balanced with risks and burdens, some uncertainty in the estimates of benefits, risks and burdens.

Class 2C

Uncertainty in the estimates of benefits, risks and burdens; benefits may be closely balanced with risks and burdens.

Level of Evidence

Level of Evidence A: High Quality Evidence

Consistent evidence from well performed randomised, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk.

Level of Evidence B: Moderate Quality Evidence

Evidence from randomised, controlled trials with important limitations (inconsistent results, methodological flaws, indirect or imprecise), or very strong evidence of some other form. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate.

Level of Evidence C: Low Quality Evidence

Evidence from observational studies, unsystematic clinical experience, or from randomised, controlled trials with serious flaws. Any estimate of effect is uncertain.