What pediatric research articles are relevant for a PICO (Patient/Problem, Intervention, Comparison, Outcome) presentation?

Pediatric Research Articles for PICO Presentations

For a PICO presentation in pediatrics, prioritize recent systematic reviews and clinical practice guidelines from high-impact journals that use structured PICO frameworks, particularly those from ILCOR, ESPNIC, and other major pediatric societies published between 2020-2024.

High-Priority Guideline-Based PICO Examples

Critical Care and Resuscitation Topics

The 2022 ESPNIC guidelines on intravenous maintenance fluid therapy represent an exemplary PICO-structured approach 1. This systematic review addressed five distinct PICO questions covering fluid composition, electrolyte management, and fluid balance in critically ill children, with outcomes focused on mortality, length of stay, and specific metabolic derangements 1.

• The ILCOR 2020 Pediatric Life Support guidelines developed 21 prioritized PICO questions addressing fundamental resuscitation controversies including compression-ventilation ratios, defibrillation strategies, and automated external defibrillator use in infants 1.
• These guidelines employed GRADE methodology with systematic searches across multiple databases, evaluating outcomes of mortality, return of spontaneous circulation, and neurological outcomes 1.

Ventilator Liberation Framework

The 2024 CHEST guidelines on pediatric ventilator liberation provide a contemporary model with eight predefined PICO areas 1. This framework identified critical research gaps including extubation readiness testing, spontaneous breathing trial protocols, and post-extubation respiratory support strategies 1.

• Most recommendations were conditional based on very low to low certainty evidence, highlighting the need for multicenter randomized controlled trials and quality improvement initiatives 1.
• The guidelines specifically addressed both adult and pediatric populations with age-stratified analyses 1.

Methodological Considerations for PICO Development

Evidence Evaluation Process

The GRADE approach categorizes evidence quality as high, moderate, low, or very low based on five core domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias 1.

• Randomized controlled trials start as high-quality evidence while observational studies begin as low-quality 1.
• GRADE evidence profile tables should include patient numbers, relative risk, and absolute risk differences to enable calculation of number needed to treat 1.

Population Stratification

PICO questions should subdivide populations a priori based on age-specific disease burden, mortality risk, and available evidence 1.

• The Canadian IBD immunization guidelines stratified adult versus pediatric populations (birth through 18 years) for each vaccine-preventable disease 1.
• Critical outcomes were predetermined as mortality, disease occurrence, and serious adverse events, with immunogenicity considered a surrogate outcome 1.

Specific Clinical Domains with Strong PICO Frameworks

Perioperative Cardiac Arrest

The 2021 PERIOPCA consortium developed 22 therapy-focused PICO questions addressing intraoperative and postoperative cardiac arrest management 1. These recommendations used modified Delphi consensus with ≥70% expert agreement threshold 1.

• The guidelines acknowledged that traditional CPR algorithms require modification for perioperative settings where precipitating causes are often known but patient heterogeneity is high 1.
• Searches included PubMed, Embase, and Cochrane Library through September 2020, with inclusion of prospective trials, case-control studies, and cohort studies 1.

Antibiotic Prophylaxis in Colonized Patients

The 2023 ESCMID/EUCIC guidelines on perioperative prophylaxis in multidrug-resistant gram-negative bacteria colonization used PICO framework with critical versus important outcomes 1.

• Critical outcomes included surgical site infections caused by colonizing organisms and attributable mortality 1.
• Important outcomes encompassed all postoperative infections, all-cause mortality, length of stay, and adverse events including resistance development 1.
• The guidelines excluded pediatric populations but provide methodological templates applicable to pediatric research 1.

Pathophysiology-Focused Research

Morbidity and Mortality Analysis

The 2020 Collaborative Pediatric Critical Care Research Network study of 292 children with new morbidity or mortality identified impaired substrate delivery (54.1%) and inflammation (35.6%) as the most common pathophysiologies 2, 3.

• Structured chart review by pediatric intensivists determined that needed therapeutic advances most frequently involved new drug therapies (51.0%), cell regeneration (39.4%), and immune modulation (27.1%) 2, 3.
• The study revealed no single dominant pathophysiology or meaningful clusters, suggesting the need for diverse therapeutic approaches 3.

Common Pitfalls to Avoid

Avoid selecting studies that address unrelated populations or settings when the PICO question specifies particular contexts 1.

• Ensure English abstracts are available even when including non-English publications 1.
• Exclude case reports, conference abstracts, and letters unless higher-quality evidence is unavailable for critical topics 1.
• Verify that outcome definitions, presentation methods, and assessment timing are consistent across included studies before attempting meta-analysis 1.

Search Strategy Recommendations

Collaborate with medical librarians to develop comprehensive search equations using MESH terms across five major databases: PubMed/Medline, Web of Science, Scopus, Cochrane, and Embase 1.

• Use Rayyan software for double-blind abstract screening by at least two independent reviewers to reduce subjectivity 1.
• Perform systematic searches of systematic reviews and meta-analyses in the general population when pediatric-specific evidence is limited 1.
• Conduct focused refresh searches to capture recently published relevant studies after initial data compilation 1.