Incidence of fall-related traumatic brain injuries among older Finnish adults between 1970 and 2011.

ever, the IOM standards for external review and updating guidelines specify precisely what guideline developers must do, not simply what they must report, as in AGREE II. The IOM states that guideline developers should use a systematic review of the evidence, a tough but essential standard with the purpose to ensure that a guideline uses all of the evidence, not just that which supports the guideline developer’s point of view. The IOM specified adherence to the standards of a contemporaneous IOM report on systematic reviews, which lists 21 standards for performing systematic reviews that “minimize bias in identifying, selecting, and interpreting evidence.” AGREE II gives instructions for reporting a literature search, including and excluding studies, and assessing bias in studies. Reporting these 3 items is important, but it is not the same as specifying adherence to the 21 standards for a systematic review. These examples delineate the contrast between the IOM standards and AGREE. The IOM describes precisely what guideline developers must do to create trustworthy guidelines. Most of the AGREE standards imply what developers must do by stating what they must report. Even though we favor the more direct approach taken by the IOM, the IOM report would have been stronger if the committee had adopted 2 elements of the AGREE statement. The user’s manual in AGREE II is an important resource to improve the application of any standard. Although the IOM standards were explicit, detailed, and well-justified, a user’s guide for applying the IOM standards could have more directly and in more detail guided developers of guidelines. Furthermore, AGREE provided a scoring system for evaluating adherence to each standard. Our Viewpoint pointed out the need for a scoring system to evaluate partial adherence to the IOM standards. Both organizations did a lot of things right. Each should learn from the other.