Anatomy of a Clinical Question (PICO)

1. Patient 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 race of a patient might be relevant to the diagnosis or treatment of a disease.

2. 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 factor may influence the prognosis of the patient? Age? Co-existing problems? What was the patient exposed to? Asbestos? Cigarette smoke?

3. Comparison

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? Your clinical question does not always need a specific comparison.

4. Outcomes

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 function or test scores?

The PICO structure of the question might look like this:

Patient / Problem	stroke, without dysphagia, elderly
Intervention	oral protein energy supplements added to usual hospital diet
Comparison, if any	none, placebo added to usual hospital diet
Outcome	primary: reduce mortality; secondary: reduce serious disability risk over time

 

For our patient, the clinical question might be: In an elderly patient with a stroke, without dysphagia or trouble eating, does adding oral protein energy supplements to the usual hospital diet decrease the risk of death or serious disability over a period of several months?

 

We now go to the next section, Finding Evidence: Selecting a Resource