Asking a Clinical Question (PICO)
I. What is a PICO?
A PICO is a well-built clinical question that seeks a specific answer based on the best evidence
available. A well-constructed and thoughtful question makes the search for evidence easier.
Patient and/or population – What are the most important characteristics of the patient? Sex, age, race?
Disease history? Primary complaint?
Intervention – What do you want to do for the patient/population? Prescribe a drug? Order a test? Order
surgery?
Comparison (if relevant) – Most clinical questions, but not all, will have a comparison. The comparison
is the alternative that you want to compare to your intervention. Are you trying to decide between two
drugs, a drug and no medication or placebo, or two diagnostic tests?
Outcome – 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?
II. PICO Examples
Example 1:
In patients with atherosclerotic renal artery stenosis who have normal or mildly impaired renal function
[Population], is balloon angioplasty [Intervention] as effective as antihypertensive drug therapy
[Comparison] for reducing blood pressure [Outcome]?
Example 2:
In patients with normal renal function who have had recent surgery [Population] are nonsteroidal antiinflammatory drugs (NSAIDs) [Intervention] associated with adverse renal effects [Outcome]?
Example 3:
Among young children with acute asthma exacerbation [Population], is a single dose of IM
dexamethasone [Intervention] comparable to five days of oral prednisolone [Comparison] for resolution
of asthma symptoms [Outcome]?
III. PICO Hints
o PICO format works best for questions about therapies or other interventions (things you will do to
patients).
o Some questions you may have about a patient are Background Questions and are best answered by
going to a review article or textbook. (e.g. What are the diagnostic criteria for sinusitis?) These are
not PICO questions.
o PICO (Foreground Questions) are patient-centered problematic questions. They involve interpretation
and consideration of the risks vs. benefits for a patient or group of like patients.