The earliest reference I can find seems to be this one, though I can't open the PDF to see if it refers back to something earlier:

Oxman AD, Sackett DL, Guyatt GH. Users' guides to the medical literature. I.
How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993 Nov
3;270(17):2093-5. PubMed PMID: 8411577.

http://www.ncbi.nlm.nih.gov/pubmed/8411577

 

Bill Cayley, Jr, MD MDiv
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On Wednesday, May 13, 2015 11:07 AM, Jon Brassey <[log in to unmask]> wrote:

Hi All,

I've just been asked about the origins of PICO and I have no idea! I'm hoping someone will know.

Who devised/first used the phrase and is there an original paper describing its application?

Best wishes

jon