Case in Point: How to Write an Effective Case Report or Series
William J. Sauer, M.D.
Case reports continue to play a critical role in the advancement of medicine, particularly with regard to new disease entities (e.g. AIDS and Kaposi Sarcoma), adverse reactions (e.g. thalidomide associated birth defects), as well as other novel observations (see Table1). As an example, there is currently a lot of attention from the CDC and NEJM correspondence regarding vaping-associated lung injury, yet a well written case report was published over two years ago.
Although often labelled as low quality of evidence, the objective of these publications are entirely different from a randomized controlled trial. Instead of directly impacting medical decision making, case reports should inspire creativity, promote engagement, and further investigations. They function to alert clinicians of new or rare phenomena that cannot be described in RCTs. Several specialties, including surgery, infectious disease, and pharmacology, rely on case reports to support their foundation of knowledge.
In an era of information overload, the delivery of these “clinical stories” is particularly important as the audience can quickly become un-engaged. Several resources, including the CARE (CAse REport) guidelines and checklist, should be used to ensure accurate and intriguing presentation of the intended message.
Tips from the CARE Guidelines include2:
- Clearly identify the message. The title should succinctly describe the primary interest the author hopes to describe.
- Create a timeline. The patient(s) chief complaints, clinical course, and outcome should be articulated in a chronological and engaging manner.
- Complete the remainder using specialty-specific information with references. Highlight key words as well as references (if available) to summarize findings.
- De-Identify patient information. Informed consent needs to be obtained.
- Follow journal-specific submission requirements/ guidelines. Unfortunately, a smaller number of journals are publishing case reports/ series.
1) Vandenbroucke JP. In Defense of Case Reports and Case Series. Ann Intern Med. 2001; 134(4):330-4 (see attached PDF for article)
2) CARE case reports guidelines. www.care-statement.org. (see attached PDF for article)
3) Gagnier JJ, et al. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob Adv Health Med. 2013; 2(5): 38-43.
4) Riley DS, et al. CARE guidelines for case reports: explanation and elaboration document. Journal of Clinical Epidemiology. 2017; 89:218-235