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The Rational Clinical Examination: Evidence-Based Clinical Diagnosis

TABLE: Levels of Evidence

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    AMA Citation
    TABLE: Levels of Evidence. In: Simel DL, Rennie D. Simel D.L., Rennie D Eds. David L. Simel, and Drummond Rennie.eds. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis New York, NY: McGraw-Hill; 2009. http://jamaevidence.mhmedical.com/content.aspx?bookid=845&sectionid=70850924. Accessed January 17, 2019.
    MLA Citation
    . "TABLE: Levels of Evidence." The Rational Clinical Examination: Evidence-Based Clinical Diagnosis Simel DL, Rennie D. Simel D.L., Rennie D Eds. David L. Simel, and Drummond Rennie. New York, NY: McGraw-Hill, 2009, http://jamaevidence.mhmedical.com/content.aspx?bookid=845&sectionid=70850924.

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Levels of Evidencea
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Levels of Evidencea
Level of Evidence Grade Definition
1 A Independent blinded comparison of sign or symptom results with a criterion standard of diagnosis among a large number of consecutive patients suspected of having the target condition
2 B Independent blinded comparison of sign or symptom with a criterion standard of diagnosis among a small number of consecutive patients suspected of having the target condition
3 C Independent blinded comparison of sign or symptom with a criterion standard of diagnosis among nonconsecutive patients suspected of having the target condition
4 C Nonindependent comparison of sign or symptom with a criterion standard of diagnosis among samples of patients who obviously have the target condition plus, perhaps, normal individuals
5 C Nonindependent comparison of sign or symptom with a standard of uncertain validity

aModified from Holleman and Simel.13

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