When this patient scenario was encountered on our clinical service, the housestaff generated several clinical questions including:
Can ASA decrease the risk of stroke?
Does a carotid bruit predict significant carotid stenosis?
How effective is a carotid endarterectomy in someone with moderate carotid stenosis?
Note that these questions ask for specific knowledge about the diagnosis and management of the patient. Well-built clinical questions should have 4 components:
Patient or Problem
Intervention
Comparison Intervention
Outcome
Description of the patient or the target disorder of interest
Could include:
Exposure
Diagnostic test
Prognostic factor
Therapy
Patient perception etc.
Relevant most often when looking at therapy questions
Clinical outcome of interest to you and your patient
Returning to the 3 questions that we posed above, how can we make them into well-built clinical questions?
Let's look at the first question:
Patient or Problem
Intervention
Comparison Intervention
Outcome
65 year old man with a stroke and moderate carotid stenosis
ASA
Placebo
Stroke
Now we can use this to formulate our clinical question:
In a 65 year old man with a stroke and moderate carotid stenosis, can ASA decrease the risk of another stroke compared with no treatment?
Try formulating a well-built question yourself using the last 2 questions that were posed by our housestaff:
