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What is PICO?

The PICO framework is an effective tool for constructing a well built clinical question.

PICO stands for:

Patient or Problem
Intervention
Comparison intervention (if appropriate)
Outcome(s)

A well built clinical question:

  • gives you a head start in finding information that is relevant (applicable to the patient) and valid (accurately measures what the authors state they intend to measure.)
  • provides you with a checklist for the main concepts to be included in your search strategy.
  • allows you to find information quickly. If tracking down the evidence takes too long, you will probably avoid it in your clinical practice.

From 'Formulate a Clinical Question', The University of Western Australia

Asking answerable clinical questions using PICO

P - Patient, Population, or Problem How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age, or ethnicity of a patient might be relevant to the diagnosis or treatment of a disease.

I - Intervention, Prognostic Factor, or Exposure Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factors may influence the prognosis of the patient? Age? Co-existing problems? What was the patient exposed to? Asbestos? Cigarette Smoke?

C - Comparison of Intervention (if appropriate) What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Tour clinical question may not always have a specific comparison.

O - Outcome you would like to measure or achieve What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve functions or test scores? (Source: Ebling Library, University of Wisconsin-Madison)


Example of a PICO question

Patient or Problem

Intervention

Comparison

Outcome

Child with frequent, recurrent acute tonsillitis

Antibiotics

Tonsillectomy

Tonsillectomy is warranted in children with frequent, recurrent acute tonsillitis

Type of  evidence

TRIP database – evidence based guidelines

Cochrane database of systematic reviews (synthesis of randomised controlled trials)