Searchable Clinical Questions
PICO is a mnemonic used to describe the four elements of a good clinical foreground question. The PICO model is used in Evidence-Based Practice to assist in formulation of searchable clinical questions.
The first challenge faced by an EBP clinician is to identify an information gap. In patient care often the first inkling of trouble is a vague uneasines about some issue of diagnosis, treatment, or prognosis. The healthcare provider must identify questions from amid the complexity of clinical care. The questions must be refined to make them searchable in information resources. In practice, well-built clinical questions usually contain four elements, summarised below.
Scenario:
You are on call for your practice. The mother of a 23 month old female with a history of prematurity and recurrent ear infections calls in to ask about fever control. The child was seen and diagnosed by another physician today with a middle ear infection. Amoxicillin was prescribed and the parents gave a first dose this afternoon. The child received acetaminophen one hour ago for a fever of 102 degrees F orally; the fever has not changed. The mother is concerned, her child seems miserable and she wants to know what to do. You have many questions in mind as you talk with the mother. Did the mother give the right dose of acetaminophen for the child's weight? Could there be something other than otitis media causing the child's symptoms? One question is whether ibuprofen might be better for fever control than acetaminophen?
Use PICO to create a searchable question...
The terms we might use to look up information based on the PICO model: infant, fever, acetaminophen, ibuprofen.
Read more about PICO in these journal articles:
- Huang X, Lin J, Demner-Fushman D. Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc. 2006:359-63. PubMed PMID: 17238363; PubMed Central PMCID: PMC1839740.
- Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007 Jun 15;7:16. PubMed PMID: 17573961; PubMed Central PMCID: PMC1904193.
We now have search terms we might use; continue on to Step 2: Accessing/acquiring information.