Hello,
Last year I asked you to take part in a survey on what structure would you use for a
focused question on diagnosis, using PIO PICO or PECOT. The aim was to find out people
use for the P, I/E C and O. There were 16 respondents (thank you all). The discussion was
continued at the 5th International EBHCTD conference in Sicily in Oct/Nov 2009. I said
that I would feed back the results.
There was almost virtual agreement about P = population with the symptom, but there
was a tremendous variation in the other parts of the question..
The most favoured combination was this:
I/E = the test
C = the reference standard
O = presence of disease
Also popular was a slight variation on this:
I/E = test result positive
C = the reference standard
O = presence of disease
There were powerful, even though minority, arguments against these variants. Many
people commented that this is a difficult area (and some that PICO is better forgotten for
diagnostic questions altoghether!). I can make these arguments available (eventually) to
those who are interested. Please email me if you want more information as it becomes
available.
FYI, the scenario presented for discussion was:
Sciatica is a musculoskeletal symptom in which pain is felt along the length of the leg. A
test, known as the straight leg raise (SLR), puts the sciatic nerve under tension. A
positive SLR is taken to suggest one cause of sciatica: intervertebral disc herniation or
disc rupture.
This would translate in the popular variants as:
P = people with sciatica
I/E = SLR OR SLR positive
C = MRI showing disc herniation
O = disc herniation
Best wishes,
Kev Hopayian
GP Suffolk and GP Tutor, School of Medicine, Health Policy and Practice, University of
East Anglia, Norwich, England
|