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Begin with the Question, or What is a PICO?

Begin with the Question, or What is a PICO?. Michael K. Gould, MD, MS Vice Chair, ATS DDIC May 13, 2011. Why PICO?. Clearly articulates questions to be addressed Facilitates literature search Defines specific components of individual recommendations

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Begin with the Question, or What is a PICO?

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  1. Begin with the Question, or What is a PICO? Michael K. Gould, MD, MS Vice Chair, ATS DDIC May 13, 2011

  2. Why PICO? • Clearly articulates questions to be addressed • Facilitates literature search • Defines specific components of individual recommendations • A PICO for every recommendation and a recommendation for every PICO! • Helps to determine scope of document • Each PICO requires its own literature search!

  3. What is a PICO(S)?

  4. Example: VTE Prophylaxis

  5. PICO Question • Among patients undergoing major abdominal surgery, should LDUH versus no prophylaxis be used for VTE prevention? • Are we confident that the benefits of reducing fatal and non-fatal VTE exceed the harms of increasing fatal and non-fatal major bleeding?

  6. Safety and Effectiveness of LDUH: IMT

  7. Collins Meta-analysis NEJM 1988;318:1162-1173.

  8. Results: Meta-analysis

  9. PICO Question • Among patients undergoing major abdominal surgery, should LDUH versus no prophylaxis be used for VTE prevention? • Are we confident that the benefits of reducing fatal and non-fatal VTE exceed the harms of increasing fatal and non-fatal major bleeding? • When stratified by risk for VTE? • When stratified by risk for major bleeding complications?

  10. Estimating Baseline Risk Ann Surg 2010;251:344-50

  11. Recommendation For major abdominal surgical patients at moderate risk for venous thromboembolism who are not at high risk for peri-operative bleeding, we suggest use of low-dose unfractionated heparin (Grade 2B) over no prophylaxis.

  12. Recommendation For major abdominal surgical patients at high risk for venous thromboembolism who are not at high risk for peri-operative bleeding, we recommend use of low-dose unfractionated heparin (Grade 1B) over no prophylaxis.

  13. PICO Checklist • Are all elements of the research question described in sufficient detail? • Is the question important to clinicians and patients? • Are the outcomes important to patients? • For surrogate outcomes, is the link between the surrogate and the patient-important outcome clearly established?

  14. Need Help? • Jerry Krishnan, DDIC Chair • Michael Gould, DDIC Vice Chair • mgould@usc.edu • Kevin Wilson, ATS Documents Editor • Jan Brozek, ATS methodologist • Judy Corn, ATS Staff • Your friendly DDIC Liaison

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