What is a case report?

A case report can be defined as ‘A detailed description of the experience of a single patient’. Taber’s cyclopedic medical dictionary’s definition is a bit more elaborate: ‘A formal summary of a unique patient and his or her illness, including the presenting signs and symptoms, diagnostic studies, treatment course and outcome.

If more than a single case is reported, it is called a case series or case series report. These usually consist of 3–10 cases.

The case report is most often a descriptive and naturalistic study as opposed to experimental research. Furthermore, it follows that it is retrospective. It is not part of a planned and designed research project.

Why do you need to learn about case reports?

Case reports are a time-honored tradition in the medical profession. From Hippocrates (460 B.C. to 370 B.C.),and even arguably further back since the papyrus record of ancient Egyptian medicine (c. 1600 B.C.) to modern day, physicians of all specialties have described interesting cases involving all specialties. Although case reports are regarded by some as the lowest in the hierarchy of evidence in the medical literature, they do have genuinely useful roles in medical research and evidence-based medicine. In particular, they have facilitated recognition of new diseases and adverse effects of treatments. (For example, recognition of the link between administration of thalidomide to mothers and malformations in their babies was triggered by the report of a particular case.). Case reports also have a role in pharmacovigilance. They can also help understand the clinical spectrum of rare diseases, as well as unusual presentations of common diseases. They can help generate study hypotheses, including plausible mechanisms of disease. Case reports may also have a role to play in guiding the personalization of treatments in clinical practice, and they provide important clinical findings that may be missed or undetected in clinical trials.

When to write a case report?

Different journals have different criteria for publication, and for when to write a case report but general criteria include: original and interesting case reports that contribute significantly to medical knowledge and have an educational value. Manuscripts must meet on of the following criteria;  unreported or unusual side effects or adverse interactions involving medications; unexpected or unusual presentations of a disease; new associations or variations in disease processes; presentation, diagnoses, and/or management of new and emerging disease; an unexpected association between diseases or symptoms; an unexpected event in the course of observing or treating a patient;  findings that shed new light on the possible pathogenesis of a disease or an adverse effect.

How to start?

Now let us discuss the brass tacks of writing the actual case report by going through the individual sections that will comprise the manuscript.

The main structure of a case report is composed of:

• Abstract
• Introduction (Background)
• Case presentation
• Discussion
• Conclusion
• References

1-Title page

The first page of the manuscript should be a dedicated title page, including the title of the article. The title should be a clear and short description of the case with a list of the full names, institutional addresses and email addresses for all authors.

There should always be at least one corresponding author who is clearly identified.

Abbreviations with in the title should always be avoided.

It is also important to avoid any puns or overly cute wording with in the title and try to keep things strictly descriptive and clear.

The title needs to accurately describe the case, because this may be all that someone reads.

Most references agree that a title should not exceed 20 words.

2-Abstract

The Abstract is very important because this is often all that people will read, and its availability will allow easy retrieval from electronic databases and help researchers decide their level of interest in the case report.

The Abstract should be a concise and condensed version of the case report “short and sweet”. It should not exceed 350 words (most references advice 100-250 words). Abbreviations or references within the Abstract should not be used.

The Abstract should be structured into three sections:

• Background: an introduction about why this case is important and needs to be reported.
• Case presentation: brief details of what the patient(s) presented with, including the patient’s age, sex and ethnic background.
• Conclusion: a brief conclusion of what the reader should learn from the case report and what the clinical impact will be.

Please include information on whether this is the first report of this kind in the literature

Guiding tip:

You can try writing the Abstract after you finish writing all other sections, because it tends to flow easily after investing your time in thought and writing of the manuscript.

3- Keywords:

This section is comprised of three to ten keywords representing the main content of the article.

Keywords are important for indexing the manuscript and easy online retrieval.

4- Introduction (Background):

The introduction or background serves as the sales pitch for the rest of the manuscript. It should be concise and salient.

The introduction section should explain the background of the case, including the disorder, usual presentation and progression, and an explanation of the presentation if it is a new disease. It should also include a brief literature review.

This should give an introduction to the case report from the standpoint of those without specialist knowledge in the area, clearly explaining the background of the topic.

Guiding tips:

• If the case is discussing an adverse drug interaction, the introduction should give details of the drugs’ common use and any previously reported side effects.
• The introduction should end with a brief statement of what is being reported in the article.

5- Case presentation:

This part should present all relevant details concerning the case.

This sections should contain any relevant medical history of the patient; the patient’s symptoms and signs; any testes that were carried out and a description of any treatment or intervention.

In this section, the case should be described in a concise and chronological order. One should usually begin with the primary complaint, salient history (significant family, occupational, and other social history along with any significant medications taken or allergies), followed by the physical examination, starting with the vital signs presented at the examination, along with pertinent investigations and results.

Guiding tips:

• If it is a case series, then details must be included for all patients.
• This section may be broken into subsections with appropriate subheadings.

6- Discussion:

The Discussion severs to summarize and interpret the key findings of the case report, to contrast the case report with what is already known in the literature and justify its uniqueness, to derive new knowledge and applicability to practice, and to draw clinically useful conclusions.

In comparing the new case with prior knowledge, the author should briefly summarize the published literature and show in what aspect the present case differs from those previously published, and thus deserves to be published.

Any limitations of the case should be stated in this section and the significance of each limitation described.

The value that the case adds to the current literature should be highlighted, so should the lessons that may be learnt from the case presented.

7- Conclusions:

In this part, you should give a clear explanation of the importance and relevance of the case report.
You should mention if it is an original case report of interest to a particular clinical specialty of medicine or if it has a broader clinical impact across medicine.
You should include information about how this case report will significantly advance our knowledge of a particular disease etiology or drug mechanism.
This part should be short and concise with clear take-home messages and teaching points.

8- References:

As an author, you must search and cite published case reports that are relevant to the case they are presenting. There should be no more than 15-20 references usually, although this number can differ slightly between journals. Unless the references are of historic interest, you should keep them as contemporary as feasible (within the last 5 years or so). You should also avoid excessive referencing.

What are the other parts of the manuscript?

The aforementioned part concludes the main structure of a case report. In the next part, we will address key parts of the manuscript that every author should know about. These differ in their importance according to the journal you choose to publish with.

List of abbreviations

When abbreviations are used in the text, they should be defined in the text at first use, and a list of abbreviations can be provided.

The list of abbreviation should precede the competing interests and authors’ contributions sections

This is important for the reader who may not be with the particular specialty that the case is reported in.

You should also keep in mind that non-medical professionals may read the manuscript as well.

Consent

This section should provide a statement to confirm that the patient has given their formed consent for the case report to be published. The written consent should not routinely be sent in along with the manuscript submission (due to patient privacy issues), but the journal may request copies of the consent documentation at any time.

If the individual is a minor, or unable to provide consent, then consent must be sought from his or her parents or legal guardians. Please keep in mind that the manuscripts will not be peer reviewed if a statement of patient consent is not present. In practice, you can start with written consent from the patient. If the patient is incapacitated or deceased, you can obtain the consent from the patient’s next-of-kin.

Guiding tips:

• When contacting the journal, the following wording regarding the consent is recommended: “Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-chief of this journal”.
• You can keep copies of consent forms in your office for easy access.
• If the patient has died, you can try obtaining the consent from the patient’s next-of-kin.
• If you are unable to obtain consent after contacting the next-of-kin of the patient who has died you can write to the journal the following: “written informed consent could not be obtained from the deceased patient’s next-of-kin for publication of this case report and accompanying images despite all reasonable attempts. Every effort has been made to protect the patient’s identity and there is no reason to believe that our patient would have objected to publication”.

Competing interests:

A competing interest exists when one’s interpretation of data or presentation of information may be influenced by a personal or financial relationship with other people or organizations.

Authors must disclose any financial competing interests and should also reveal any non-financial competing interests that may cause embarrassment were they to become public after the publication of the manuscript.

Authors are required to complete a declaration of competing interests. You should list the declared competing interests at the end of published article.

Guiding tips:

• you can use the following wording: “the author(s) declare that they have no competing interests”.

Authors’ contributions:

In order to give appropriate credit to each author of a paper, the individual contributions of authors to the manuscript should be specified in this section.

An ‘author’ is generally considered to be someone who has made substantive intellectual contributions to a published study.

To qualify as an author, one should:

• Have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data.
• Have been involved in drafting the manuscript or revising it critically for important intellectual content.
• Have given final approval of the version to be published.

Acquisition of funding, collection of data, or general supervision of the research group, alone, does not justify authorship.

All contributors who do not meet the criteria for authorship should be listed in an acknowledgements section.

Examples of those who might be acknowledged include a person who provided purely technical help, writing assistance, or a department chair who provided only general support.

Authors’ information:

This section includes any relevant information about the author(s) that may aid the reader’s interpretation of the article and understanding of the standpoint of the author.

This may include information about the author’s qualifications, current positions they hold at institutions or societies, or any other relevant background information.

Guiding tips: 

• Please refer to authors using their initials.
• In this section you should not describe competing interests.
• In practice, you can use this section to advertise you services.

Acknowledgements:

Authors should acknowledge anyone who contributed towards the article by making substantial contributions to conception, design, acquisition of data, or analysis and interpretation of data, or who was involved in drafting the manuscript or revising it critically for important intellectual content, but who does not meet the criteria of authorship.

You should also include the source of funding for each author, and for the manuscript preparation, authors must describe the role of the funding body, if any, in the: design, collection, analysis, and interpretation of data.

Please acknowledge anyone who contributed materials essential for the study.

If a language editor has made significant revision of the manuscript, I recommend that you acknowledge the editor by name.

You can also acknowledge (anonymously) the patient on whom the case report is based.

It is very important to obtain permission to acknowledge from all those mentioned in the acknowledgements section.

Cover letter:

This is a separate document that should be written and uploaded with the main manuscript submission.

The cover letter should be addressed to the Editor-in-Chief in a formal manner and include all of the authors’ contact information.

It should clearly and concisely state the title of the manuscript, and why the authors feel that their case report should be published based on any already available literature on the topic at hand.

The cover letter is very important as that is the first thing that the editor reads and serves as the gateway to the abstract and then the rest of the manuscript.

Resources:

In this section we will provide some resources that a novice author can use for further reading on writing case reports and case report formatting, in addition we will provide some useful resources for literature review.

For further readings on case report writing:

In this article, you can read further information on writing a case report. The checklist at the end of the article is particularly helpful:

http://www.ajhp.org/content/63/19/1888.long?sso-checked=true

In this article, you can find the importance of writing and publishing case reports during medical training:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820008/

In this article, you can have further readings about ensuring a meaningful contribution to the literature when writing a case report. You can also check out the check lists in the article that will help you organize the case, making sure you don’t miss anything:

https://sci-hub.tw/10.1016/j.aucc.2007.08.002

The CARE guidelines, developed by an international group of experts, are designed to increase the accuracy, transparency, and usefulness of case reports. Through CARE guidelines, authors can obtain help in writing their case report through templates and checklists.

http://www.care-statement.org

Resources regarding literature review when writing a case report:

PubMed:

PubMed is a free resource that provides access to MEDLINE, the national library of medicine database of citations and abstracts in the fields of medicine, nursing, veterinary medicine, healthcare systems, and preclinical sciences. It is a free resource that is developed and maintained by the National Center for Biotechnology Information (NCBI), at the U.S. National Library of Medicine (NLM), located at the National Institutes of Health (NIH).

PubMed is where you want to start as a literature review resource.

PubMed’s official website:

https://www.ncbi.nlm.nih.gov/pubmed/

You will need to learn about PubMed and how to use it , and you can do that via this link below which provides a full online training program on PubMed :

https://learn.nlm.nih.gov/documentation/training-packets/T0042010P/

If you are looking for a quick guide to access PubMed and to learn how to use it you can click this link which will lead you to quick start guide including frequently asked questions and YouTube tutorial videos that you can access for free :

https://www.ncbi.nlm.nih.gov/books/NBK3827/#pubmedhelp.PubMed_Quick_Start

https://www.youtube.com/playlist?list=PLBD13A2628C7A9965

The national center of biotechnology information:

This website can  speak for itself. It is very important to learn how to use it.

Official website:

https://www.ncbi.nlm.nih.gov/

This is a YouTube tutorial on how to use the website :

https://www.youtube.com/watch?v=hTTvq8KJthA

Journal of Medical Case Reports:

Journal of medical case reports will consider any original case report that expands the field of general medical knowledge, and original research relating to case reports. All articles published by JMCR are made freely and permanently accessible online immediately upon publication, without subscription or charges or registration barriers.

Official website:

https://jmedicalcasereports.biomedcentral.com/

BMC:

A pioneer of open access publishing, BMC has an evolving portfolio of high quality peer-reviewed journals. Official website:

https://www.biomedcentral.com/

Additional literature review resources:

Google Scholar provides a simple way to broadly search for scholarly literature. Official website :

https://scholar.google.com/

Simple YouTube tutorial on how to use google scholar and its features:

https://www.youtube.com/watch?v=yDbghsm_d6Q

https://www.youtube.com/watch?v=aTi7EnN_kRI

You can also visit Cochrane library and up to date which are considered important resources for literature review but unfortunately they only have limited access to a lot of their journals.

Official Cochrane library website:

http://www.cochranelibrary.com/

Official up to date website:

https://www.uptodate.com/home

I hope these resources can give you the start you need as a novice author. By exploring each and every resource you might be able to form your own database that you recall when writing case reports and any other kinds of manuscripts.

Credits:

Content created by Emad Dakhkhan

Content reviewed by Alexey Youssef, MD