|PRACTICAL ADVICE PAPER
|Year : 2013 | Volume
| Issue : 2 | Page : 126-129
Writing patient case reports for publication
Deepak Juyal1, Shweta Thaledi2, Vijay Thawani3
1 Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Srinagar Garhwal, Uttarakhand, India
2 Department of Microbiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
3 Senior Program Officer, Lata Medical Research Foundation, Vasant Nagar, Nagpur, Maharashtra, India
|Date of Web Publication||29-Oct-2013|
Department of Microbiology and Immunology, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Srinagar Garhwal, Uttarakhand - 246 174
Source of Support: None, Conflict of Interest: None
A case report is a description of a clinical case that has unique features. It may include a previously unreported clinical condition or observation of a disease, a unique use of imaging or diagnostic tool to reveal a disease, a new therapeutic intervention of a known disease, a previously unreported complication of a disease, or a new adverse event from a medication. A case report should be crisp, focused, and include few figures and references. A case report generally has a short unstructured or no abstract, a brief or no introduction, a description of the case, a discussion and a brief conclusion. Case reports are valuable sources of new and unusual information that may stimulate further research and applicability to clinical practice. Writing case reports properly is important if they are to be accepted by journals and credible and useful to readers.
Keywords: Evidence-based medicine, impact factor, medical writing, peer review, scientific paper
|How to cite this article:|
Juyal D, Thaledi S, Thawani V. Writing patient case reports for publication. Educ Health 2013;26:126-9
| Context|| |
Shunned by some and adored by others, reporting a rare or unusual case is probably the oldest form of medical writing.  Case reports have been used to teach health sciences students and are a good way for authors to get started in scholarly writing. , A case report shares new clinical experiences and knowledge in the practice of medicine with the interested reader. It can describe a new disease, treatment, or complication. Well documented case reports provide a direction to future clinical studies to augment evidence-based medicine. , In the hierarchy of study designs, randomized controlled trials are at the top, followed by controlled trials, then observational studies, case control studies, case series, and then case reports, with expert opinion and consensus at the bottom.  But irrespective of its standing, getting case report published in a scientific journal is a good way to initiate and groom future research scholars for scientific writing.
For many budding researchers, writing a case report is the first time they will see their name in print as an author. Getting a case report accepted for publication in a journal is generally not difficult if one knows what is required. Aspiring authors should review the instructions to authors on the journal's website. It also helps to read others' published case reports to learn how others have approached their topics. The authors should also have an understanding of the journal's peer review and publication processes. Before writing the case report, authors should perform a thorough online literature search on as many search engines as possible, to check if others have reported similar cases with similar learning points. If already extensively reported, the case is probably not worth reporting again. The authors should be aware of the specific requirements for a case report so that their manuscript is drafted according to the prescribed guidelines of their target journal.
| Why write a case report?|| |
Many agree that case reports have their own rightful place in the published literature and provide new knowledge to the field of healthcare. , Case write-ups remain one of the few ways to bring new conditions or new etiologies quickly and conveniently to the attention of the scientific community  A list of the reasons to publish an interesting case is provided in [Table 1].
| What Should be Reported?|| |
Describing a single case with unique features is what constitutes a case report. However, it is quite unlikely that a physician will encounter an entirely new and original medical entity, but not uncommon for them to see rare or unusual clinical findings in patients that warrant description and dissemination through case reports. Thus, encountering previously unreported observations of a known disease, using unique diagnostic procedure to reveal a disease, or witnessing a previously unreported complication of a procedure are examples of things worthy of a case report. The case report should contribute new knowledge to the understanding, diagnosis, or management of a known disease. There must be a clear learning message for the reader. Ideally it should provide insight that can lead to further research on the topic.
| Usual Format of Case Report|| |
Patient case reports may describe a single case or a short series of cases. The case report should be brief and focused, with a limited number of figures and references. The structure of a case report usually comprises a short, unstructured abstract, or none at all; brief or no introduction; a case description; and a discussion that includes a literature review, summary, and conclusion. Typically the number of authors contributing the case report is few. Supplemental parts such as tables, figures, and graphs can provide important data and enhance the article's flow and clarity, but not all journals allow these with case reports because of space constraints. Electronic journals, in which copy space has no additional costs, can be more liberal in this regard. There is wide variation across journals in the required format of case reports. so it is important for authors to follow the instructions of their targeted journal. [Table 2] lists the standard sections of a case report [Table 2].
Before writing a case report authors should scan recent issues of their targeted journal to verify that they publish case reports, as many journals do not. The reasons some journals publish few or no case reports include space constraints, prioritizing other types of submissions, and their negative effect on a journal's impact factor given the low citation rate of case reports compared with other types of scientific papers.  If the target journal accepts case reports, authors should review recently published papers to understand how and in what format the journal publishes them. In general, case reports have the following format:
| Title|| |
The title of the case report should be accurate, brief, clear, perhaps catchy, and succinct enough to interest the reader. Redundant words such as "case report "or "review of" should not be used in title. 
| Abstract|| |
Some journals do not allow abstracts for case reports. If allowed, the abstract is generally unstructured and contains 100-150 words. Allowing abstracts helps papers be more easily found through electronic databases and helps readers discern their level of interest in the case report. The case report abstract should include the age and gender of patient, salient clinical information, ultimate diagnosis, management, follow-up, and the take home messages for the reader.
| Introduction|| |
The purpose of the case report should be clearly described in the Introduction. Background information should be provided to demonstrate how the case contributes to the existing literature.  The rationale for the case report should be supported by limited, relevant references, which allow the author to relate the context of the case in relation to previously published data, but being mindful not to delve in depth into the subject. The Introduction generally should be of one paragraph in length and a maximum of 100 words. Some journals do not allow introductions for case reports, and instead the body of the article starts directly with the case description.
| Case Description|| |
This constitutes the main body of the case report. Here, the order of events of the case should be presented in chronological order including the clinical history, physical examination findings, investigation results, differential diagnosis, working diagnosis, management, follow-up, and final diagnosis. Basic patient information should be provided like age, gender, occupation, ethnicity, height, and weight. Clarity is essential, especially with regard to important findings. Signs and symptoms should be described with relevant past personal medical and family history. Details of previous medication, any medicine allergy, reports of laboratory work, electrophysiological tests, and imaging techniques should be provided. Pertinent negative findings should also be included.
Care should be taken to maintain patient's confidentiality. The patient should not be identifiable from any information or photo contained in the case report. In the accompanying images all the identifiable features should be concealed or removed, taking special care to conceal the eyes. The written informed consent from patient or parent/guardian (if the patient is minor), and the next-of-kin (if patient has died) should be obtained with permission to publish the case report and accompanying images. Journals will often require this and may ask for documentation.
The authors should establish a causal and temporal relationship and indicate the effect of treatment, any unanticipated effects, the final outcome, any further proposed treatment and the patient's status at the time of the report's writing. The case presentation should only include information that pertains to the case and refrain from providing confusing and superfluous data. A case report containing detailed and relevant clinical information allows the inquisitive reader with clinical research expertise and stimulates further research inquiry.
| Discussion|| |
This important section of the case report should be brief and to the point. The authors may suggest their own hypothesis and offer their opinions about the case here.  The Discussion should compare the case with similar cases in the published literature, evaluate the case for accuracy, and develop new information and point out applicability to clinical practice.  The value that the case adds to the current knowledge should be highlighted and any limitations of the case should be stated.  Authors should also try to point out possibilities for worthwhile future investigation, and diagnosis and management of similar cases.  In the last paragraph, the conclusion and explanation of its relevance should be provided. The conclusion should not be summary of the entire case. The take home points should be mentioned with focus on what has been learned from the case and should relate to the purpose of the paper. Far reaching, sermonizing, prophetic, unsupported, general statements should not be made. 
| Acknowledgement|| |
Journals often do not permit Acknowledgements for case reports. If appropriate, authors may briefly acknowledge the work of a colleague who assisted the author(s) in manuscript preparation but whose contributions overall do not justify authorship. Statement of consent from patient or acknowledging the anonymous patient on whom the case report is based is not needed. Some journals stipulate that people acknowledged must give written consent for their name to appear in print.
| Authorship|| |
Authorship status should be restricted to those who have made substantial, intellectual contributions to the manuscript. This may include clinicians who participated in patient diagnosis and management sufficiently to take public responsibility, as long as they also contributed to the manuscript's writing and review. Some journals restrict the number of authors for case reports. 
| References|| |
References should be limited to those directly relevant to the case; generally not more than 10-15.  Authors should use the most recent relevant references, preferably within the preceding five or so years. References should be formatted according to the journal's instructions: Many journals follow the Vancouver style of referencing.
| Supplementary parts|| |
This includes tables, figures, and graphs, which provide additional data to support the text and provide the reader with more detail. This data should not duplicate that within the text. Journals may change their policies permitting and/or requiring tables, figures, and graphs given the changes in publication technology. 
| Conclusion|| |
Case reports are a component of evidence-based medicine and informed practice. These serve as valuable sources of information on new and unusual clinical observations that may lead to subsequent research advances. The case should be reported honestly, factually, and as early as possible. The case report must have a clear learning point that adds to the current understanding of a known disease, its diagnosis, and/or management. Young research scholars can get initiated in scientific writing through writing case reports.
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[Table 1], [Table 2]
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