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Evidence-Based Practice

Type of Questions

Next, determine what type of question you have. This will help you phrase your clinical question and determine which study design is best for your question type.

Clinical Questions: Examples Using PICO Framework

Clinical Scenario:

Your patient is an 11 month old male who has been admitted to the inpatient wards with severe respiratory syncytial virus (RSV). In addition to standard medical care, the resident wonders if treating with nebulized hypertonic saline would reduce hospital stay. What does the evidence say?

PICO:

P: infants with respiratory syncytial virus (RSV)

I: nebulized hypertonic saline

C: standard medical care

O: hospital stay

Clinical Question:

  • In ___ (P), what is the effect of ___ (I) on ___ (O) compared with ___ (C)? 
  • In infants with respiratory syncytial virus (RSV), what is the effect of nebulized hypertonic saline on hospital stay compared with standard medical care?

Clinical Scenario:

A 14 year-old girl presents with bloody diarrhea and abdominal pain. She is admitted for workup of inflammatory bowel disease (IBD) and potential diagnostic endoscopy/ colonoscopy. The attending suggests a fecal calprotectin test but another resident suggests fecal calgranulin C instead. They ask you to research the evidence.


PICO:

P: children with bloody diarrhea and abdominal pain

I: fecal calgranulin C

C: fecal calprotectin

O: detection of inflammatory bowel disease (IBD)

Clinical Question:

  • In ___ (P), is ___ (I) more accurate in diagnosing ___ (O) compared with ___ (C)?
  • In children with bloody diarrhea and abdominal pain, is fecal calgranulin C more accurate in diagnosing inflammatory bowel disease (IBD) compared with fecal calprotectin C?

Clinical Scenario:

14 year old female with no formal PMHx presenting to outside hospital via EMS with suspected anaphylaxis. Prior to arrival, patient was walking barefoot outside and felt the urge to urinate, lost consciousness, foaming at the mouth, facial swelling, emesis, diarrhea, hives, and agitation. Mother stated that patient endorsed shortness of breath during transport via EMS. Patient’s B/P was initially stable, but later dropped 73/43. Started on 0.02 epi drip and weaned to 0.01 and was given normal saline bolus x1. Patient was then transferred to the PICU for further evaluation. Stabilized and was transferred to our care. 

PICO:

P: Pediatric patients seen for anaphylaxis

I: Glucocorticoids following discharge

C: No glucocorticoids following discharge

O: Readmission for anaphylaxis 

Clinical Question:

  • For ________  (P) does the use of ______  (I) reduce the future risk of ________  (O) compared with _________  (C)?
  • For pediatric patients seen for anaphylaxis, does the use of glucocorticoids following discharge reduce future risk of readmission for recurrent anaphylaxis compared to no glucocorticoids following discharge?​

Clinical Scenario:

A 9-year-old female with juvenile dermatomyositis currently treated with IVIG, methotrexate, folic acid, and prednisone 30mg BID presents with a dermatomyositis flare. During her hospital course, she was treated with pulsed solumedrol. Her dad raised concerns for her bone health due to her history of steroid therapy for the last 1.5 years. The clinical team considered the utility of a DEXA scan as an outpatient referral to manage fracture risk in this child.

PICO:

P: Adolescents on long-term corticosteroids

I: DEXA scan

C: No imaging

O: Fracture risk

Clinical Question:

  • Does __________  (I) influence ________  (O) in patients who have _______  (P)?
  • Does DEXA screening influence fracture risk in adolescents on long-term corticosteroids?

Clinical Scenario:

AJ, is a 12 year old male who is seen in the outpatient clinic for a well child check. He is at the >99.99% for both weight and BMI. After noting that the majority of the patients seen in this clinic use formula to feed their children, we wondered if the prevalence of formula-based feeds has had any influence on future obesity risk when compared to infants who were breastfed.  
 
PICO:

P: school age children

I: formula fed (as infants)

C: breastfed (as infants)

O: obesity

Clinical Question:

  • Are ___ (P) who have ___ (I) at increased/decreased risk of ___ (O) compared with ___ (P)

with/without ___ (C)?

  • Are school age children who were formula fed as infants at increased risk of obesity compared with children who were breastfed?