Evidence-Level Framework

LevelStudy designStrength
IRandomized controlled trials (RCTs) or meta-analyses of RCTsHigh
IIProspective cohort studies, lesser RCTsModerate–high
IIICase–control or retrospective cohort studiesModerate
IVCase series or descriptive studiesLow–moderate
VCase reports, expert opinion, pathophysiologic reasoningLow