[Is there evidence in evidence-based medicine? A comparison of common gradation systems and critical evaluation].
OBJECTIVE
Evidence-based medicine is still discussed controversially. The current literature offers a huge amount of tables, recommendations and modifications for the levels of evidence and degrees of recommendations. The scientist who is critical of new techniques and who wants to continue his education might be confused by the different recommendations. Unfortunately, the gradation of the recommendations is not always cited which has led to the controversially held discussion about evidence-based medicine. It was, therefore, the aim of the current article to present the most often used gradations and to discuss them critically.


METHODS
In the current study we performed an analysis of the currently used recommendations and gradations in evidence-based medicine and discussed them critically.


RESULTS
The great number of the available divisions to evidence-based medicine are often technical and partially differ considerably. An unambiguous assignment of the evidence classes and of recommendation degrees can only succeed if the source is indicated clearly.


CONCLUSIONS
As far as the authors are concerned, the confusing status of evidence-based medicine makes one gradation necessary, which should be accepted and used worldwide.
Lüring
C
C
Orthopädische Klinik Universität Regensburg, Germany. c_luering@yahoo.de
Koester
B
B
Grifka
J
J
D019317:Evidence-Based Medicine / Q000145:classification / Q000592:standards*; D005858:Germany; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012015:Reference Standards; D015203:Reproducibility of Results; D012955:Societies, Medical