Learn how UpToDate® makes the GRADE

Tip: Make Confident Clinical Decisions with Graded Recommendations

UpToDate has always been based on the best available evidence and is transparent about the quality of evidence being used.  Since 2001, UpToDate has adopted the GRADE approach, led by Dr. Gordon Guyatt, to classify both the strength of treatment recommendations and the quality of the underlying information.  To view a topic’s graded recommendations, simply click on the "Summary and Recommendations" button at the top of the topic outline. Grades have two components: a number (1 or 2) reflects the strength of the recommendation and a letter (A, B or C) reflects the quality of the evidence supporting that recommendation. Currently UpToDate includes more than 9,600 graded recommendations. A Grade 2C recommendation is a weak recommendation based on low quality evidence, meaning that other alternatives may be equally reasonable.  A Grade 1A recommendation is a strong recommendation based on high quality evidence, meaning that this is the best course of action and the benefits clearly outweigh any risk factors. The strength and quality of a recommendation can also be identified in the topic review by the words “we recommend” for a strong recommendation and “we suggest” for a weak recommendation. Dr. Guyatt is recognized as a world leader in this area and is credited with coining the term “evidence-based medicine.” Learn more about evidence-based medicine, as well as more in-depth instruction about the GRADE system.