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Guide | Reference

17  Evidence Grading Key

Purpose. Provide a consistent way to tag statements with evidence strength and clinical utility. Make uncertainty explicit and updateable.

17.1 Evidence Strength (E0-E4)

  • E0: Conceptual, consensus, or theory only; no direct evidence.
  • E1: Case reports or uncontrolled series.
  • E2: Observational evidence with consistent associations.
  • E3: Controlled or quasi-experimental evidence.
  • E4: Replicated, convergent evidence across methods.

17.2 Clinical Utility (U0-U3)

  • U0: Background only; no direct clinical use.
  • U1: Supports assessment language or shared understanding.
  • U2: Affects differential, risk stratification, or monitoring.
  • U3: Directly changes management or safety decisions.

17.3 Tagging Format

  • Use [E?/U?] at the end of the statement, e.g., [E2/U1].
  • If unknown, use [E?] or [VERIFY] and leave for later citation work.

17.4 Current Usage

  • Selective tagging is in place for safety-critical and high-risk statements.
  • Broader tagging is deferred and not yet comprehensive.

17.5 Tagging Principles

  • Evidence tags annotate claims, not sections or whole pages.
  • Descriptive phenomenology and workflow guidance do not require tags.
  • Evidence tags reflect the state of knowledge at the time of writing; absence of a tag does not imply lack of evidence.

17.6 Citation Markers

  • Use [E2/U2] [REF] when a statement needs a citation and the reference list is not yet attached.
  • Replace [REF] later with a citation ID or formatted reference when the bibliography is in place.

17.7 When to Tag (rule of thumb)

  • Prevalence, incidence, or risk magnitude claims.
  • Causal or mechanistic assertions.
  • Treatment effects or expected response claims.
  • Safety-critical guidance (risk, rule-outs, escalation thresholds).
  • Medical or substance contributors presented as likely or common.

17.8 No Tag Needed

  • Definitions and scope statements.
  • Descriptive phenomenology language.
  • Workflow labels and documentation conventions.

17.9 Mechanism vs Association

  • Association claims can be E1-E3 depending on design.
  • Mechanism claims require E3+ to avoid overstatement.
  • If mechanism is speculative, tag as E0 and label as hypothesis.

17.10 Safety Sensitivity

  • If a statement could change safety planning, default to tagging.
  • If evidence is weak but practice-relevant, use E0/U2 and label as consensus.

17.11 Examples

  • “Insomnia is associated with increased risk of mood dysregulation.” [E2/U2]
  • “Evidence supports measurement-based care improving outcomes in depression.” [E3/U2]
  • “Caffeine can amplify panic-like symptoms in sensitive individuals.” [E1/U1]
  • “This pattern is consistent with trauma-related intrusions.” [E0/U1]

17.12 Citation Rules (for later drafting)

  • Must cite: prevalence, risk magnitude, causal claims, treatment effects.
  • Optional cite: definitions, descriptive phenomenology, clinician language.