Classification of Evidence-Based Statements

Guidelines are intended to reduce inappropriate variations in clinical care, produce optimal health outcomes for patients, and minimize harm. The evidence-based approach to guideline development requires that the evidence supporting a policy be identified, appraised, and summarized and that an explicit link between evidence and statements be defined. Evidence-based statements reflect the quality of evidence and the balance of benefit and harm that is anticipated when the statement is followed.

Guidelines are never intended to overrule professional judgment; rather, they may be viewed as a relative constraint on individual clinician discretion in a particular clinical circumstance. Less frequent variation in practice is expected for a strong recommendation than might be expected with a recommendation. Options offer the most opportunity for practice variability. All clinicians should always act and decide in a way that they believe will best serve their patients' interests and needs regardless of guideline recommendations. Guidelines represent the best judgment of a team of experienced clinicians and methodologists addressing the scientific evidence for a particular topic.

Making recommendations about health practices involves value judgments on the desirability of various outcomes associated with management options. Value judgments applied by the OME subcommittee were made in an effort to minimize harm and diminish unnecessary therapy. Emphasis was placed on promptly identifying and managing children at risk for speech, language, or learning problems to maximize opportunities for beneficial outcomes. Direct costs also were considered in the statements concerning diagnosis and screening and to a lesser extent in other statements.