What is a case report?
A case report is a basic type of research design. These reports provide a detailed narrative on one or a few patients with novel or unique clinical features. The CAse REport (CARE) guidelines are recommendations on how to present a case report study.
Why write a case report?
Case reports reside at the base of the evidence-based medicine pyramid. As such, a case report provides the first line of evidence on challenging or unusual clinical presentations, diagnoses, or treatments. For a junior investigator, a case report has the advantages of being straightforward to conduct with fairly quick publication, as well as few or no requirements for financial support. For an experienced investigator, a case report allows one to discover new clinical events and accumulate evidence on rare diseases, to create new research hypotheses or serve an educational purpose.
What are the CARE guidelines?
The CARE guidelines were initially published in 2013 and subsequently further explained and elaborated upon with examples in 2017. The guidelines provide international consensus-based recommendations to standardize the accurate and transparent presentation of a case report study. Many high-impact journals or large publishers, such as Nature Medicine, Journal of the American Medical Association, Elsevier, Springer, and Wiley, require authors to follow the CARE guidelines to present and submit a case report study.
Following the CARE guidelines
The CARE guidelines include a 13-item CARE checklist that provides a framework to construct a case report. There is also a CARE flow diagram that guides the chronological collection of clinical information.
Authors can follow the provided CARE flow diagram to systematically collect and record relevant clinical information, and then follow the CARE checklist to construct and write their case report. Before submission, authors must finalize their manuscript based on the specific requirements from their target journal.
Improving quality of case reports
In the CARE checklist and CARE flow diagram, several points deserve attention to improve the quality of a case report, such as:
1. Manuscript structure should be Title, Abstract, Keywords, Main Text (Introduction, Case presentation, Discussion, and Conclusion), References, and any necessary Figures and/or Tables.
2. The novel or unique feature of the case should be mentioned in the Title, Abstract, and Introduction, elaborated upon in the Case presentation, explained in the Discussion, and briefly reiterated in the Conclusion.
3. The patient presented in the case report likely has/had a complicated clinical course with various treatments. It is recommended to include a figure that shows the timeline of the clinical events in chronological order, as this is helpful to readers to understand the disease course. Include this figure in the Case presentation. We provide an example figure at the end of this article that can be downloaded for reference.
4. Include pictures where possible. Authors should include photographs where clinical findings can be clearly observed within the images. Certain photos, such as pre- and post-treatment images, should be presented side-by-side for easy comparison. Place these images in the Case presentation.
5. A literature review is an essential component of a case report, providing context for why this case should be published and improve our understanding of a disease. Authors are encouraged to include a table to compare the present case with previously published similar cases. The difference between the present case and previously reported cases may provide information relevant to the unique features of the present case. Include this or similar tables in the Discussion. We also provide an example table at the end of this article that can be downloaded for reference.
6. In addition to case reports, some journals accept other types of articles that describe single patients such as Clinical Pictures in The Lancet and Images in Clinical Medicine in The New England Journal of Medicine. For these submissions, authors are encouraged to use the CARE flow diagram as a template to ensure the accuracy of the collected clinical information.