Table 4.5a

USPTF Recommendation Grading System

GradeDefinitionSuggestions for Practice
AThe USPSTF recommends the service. There is high certainty that the net benefit is substantial.Offer or provide this service.
BThe USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.Offer or provide this service.
CNote: The following statement is undergoing revision. Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.
DThe USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.Discourage the use of this service.
I StatementThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

Reproduced from U.S. Preventive Services Task Force (18).

The USPSTF updated its definitions of the grades it assigns to recommendations and now include “suggestion for practice” associated with each grade. The USPSTF has also defined levels of certainty regarding net benefit. These definitions apply to USPSTF recommendations voted on after May 2007.

USPSTF indicates U.S. Preventive Services Task Force.