How to write a case report

C. Roffe

Quick guide

• Read at least 10 case reports in different journals and think about why they were reported and how the author got the message over

• Find a case which adds something new to medical knowledge

• Write the report • Compare the style and structure of your report with that

of published reports in your target journal• Spell check, grammar check and style check • Discuss with colleagues and review• Decide on journal and follow instructions• Spell check, grammar check and style check again • Submit

Important

• Students write case reports to learn about a condition by researching a particular case they have seen and writing it up as a record of their learning. They are primarily written for the benefit of the student.

• MSc case reports and case reports published in medical journals are written to teach/ inform colleagues. They should contain relevant new or unusual findings or theories.

Abstract

• Not required for all case reports• Allows easy access via Medline • About 100 words should suffice• Include• The clinical question or problem• Analysis of literature review• Brief statement of why this case is unusual

or noteworthy

Mc Carthy Fam Pract 2000

Case report topics• Cases that report hitherto unknown or unreported diseases, combination of

symptoms, presentations, side effects of drugs, or treatments

• Cases that contribute to a change in the course of medical science

• Small case series

• Cases which contradict current knowledge and generate new ideas and hypotheses

• Important personal experiences or which have led to a re-evaluation of care

See Mc Carthy Fam Pract 2000.

Introduction

• The introduction presents the topic of the case report

• Relevant background information obtained through a review of the literature should also be included

• Gives a justification of why the case is worthy of reporting

Case Presentation

• Introduce the patient and provide a history of present illness in chronological order

• Only pertinent findings from the physical exam and laboratory/imaging studies should be included

• Include normal values for less commonly ordered tests

• Write in full sentences• Avoid or explain abbreviations• Include units for measurements

Discussion

• Restate the significance of the particular case • Discuss the unusual and striking features of the

case. • Back up your discussion with additional

information obtained from your literature review to support your arguments.

• Address any contradictory evidence. • Emphasize the importance and educational

value of the case.

De Bakey Principles of case report writing I

• When you have completed the first draft of your manuscript, put it aside for a couple of weeks before you begin your critical review and revision, so that you will examine it with a fresh eye and renewed interest. Read your composition several times, concentrating on a specific criterion each time.

De Bakey and De Bakey. The case report. II. Style and form. Int J Cardiol1984;6:247-54.

De Bakey IICheck case report for

• originality and validity;

• structure and organization,

• grammatical propriety and usage,

• readability.

De Bakey and De Bakey. The case report. II. Style and form. Int J Cardiol1984;6:247-54.

Stay clear from recurrent maladies in medical writing

• Verbosity• Jargon• Imprecision• Barbarisms• Stereotypy• Illogical locutions• Improper sequence of tenses• And, finally, generally unappealing style

De Bakey and De Bakey. The case report. II. Style and form. Int J Cardiol1984;6:247-54.

And

Remember, you are writing to convey an important message, so make sure your style

and form illumine rather than eclipse or becloud that message

De Bakey and De Bakey. The case report. II. Style and form. Int J Cardiol1984;6:247-54.

But

• This is only a general guidance

• Different Journals and different case report subjects may require deviations form the standard style

• Remember to learn form examples. Read and digest case reports.

Spelling

1. Use spell checker

2. Proof read after spell checking to weed out errors introduced during spell-check

3. Check capitals/ lower case

• Drugs: generic name LC (e.g. furosemide), trade name UC (e.g. Lasix)

• Diseases: LC unless personal name e.g. Parkinson’s disease

• Names: Capitals are used for God, months, days, countries, and names (Department of Geriatric Medicine), not for professions, medical specialities, or grades (he was referred to a neurologist, the consultant responded…, geriatric medicine is a subspecialty of ….)

LC lower case UC upper case / capital

General advice based on errors of past students

• The whole story is given away in the introduction.

• Case report and discussion not linked. Discussion reads like a textbook chapter and does not relate to case.

• Presenting all that is known about the patient rather than the fact relevant to support the argument and learning point.

• Misuderstanding the terms ‘argument’ and ‘critical’ when relating to the discussion. There is no need to criticize something…..

Grammar and Style• Always write in full sentences• Do not use lists• Read the report aloud. This often brings out grammatical errors.• Make sure there are definite and indefinite articles in the right places

(foreign students often omit ‘the’ and ‘a’ in front of nouns). If unsure, check with a native speaker.

• Use 1.5 or double line space• Use 2.5 cm margins• Print size 12 point Times Roman or equivalent• Justify margins• Put a blank line between paragraphs• Start each section on a new page• Keep a consistent hierarchy of headings and subheadings• Be consistent with capitalization in headings (best to use LC except at the

beginning of the line)

Common pitfalls

• Emotional and judgemental language interesting

surprisingunfortunately

• Putting persons before factsThen the SHO reviewed his decision and referred to the neurologist who thought that this was and … arranged a lumbar puncture, which showed....

• Relating everything to yourself …The case I report, my patient, or decision, our diagnosis….

Should be avoided completely or only used when necessary to support your argument…..

Publication typesLesson of the week Lessons of the week are usually case reports or case series alerting readers to a potential clinical problem. They should be accompanied by a single sentence explaining the lesson. The lesson should be as specific as possible and aimed at a general audience (BMJ max 1200 w)

Diagnostic puzzleThese papers describe a single interesting case, which should not be a rarity but one that a general physician might encounter, in which there was some difficulty in reaching a diagnosis, and that provides a teaching point. Preferably the case should have a good illustration (Lancet max 600 w)

Interesting case Clinically interesting cases of conditions that provide new insight, describe rare but modifiable disorders or present new treatments or understanding (Age Ageing (max 600 w plus 125 word abstract).

Specialist journals

• The editors will consider case reports for publication only if they present important and unique clinical experience. Authors should limit descriptions of negative and normal findings (Stroke Max 1500 w).

• JNNP, Progress in Neurology and … , • Chest• Br J Cardiol• Gastroenterology……

Other Journals

CME Journal Geriatrics

BMJ Case reports (launched 2008) http://mc.manuscriptcentral.com/bmjcasereports

Geriatric Medicine

Health and Ageing

Case Reports and Clinical Practice Review

Medical Science Monitor

International Journal of Clinical Practice

Journal of the American Geriatrics Society

European Journal of Geriatric Medicine

Postgraduate Medical Journal

Postgraduate Medicine

Grand Rounds (open access) http://www.grandrounds-e-med.com

Journal of Medical Case reports (open access) http://www.jmedicalcasereports.com/

Other reports

• Drug points usually report new adverse drug reactions or drug interactions. They should be no longer than 300 words with five references and one table or figure. Priority will be given to drug points that report more than one case; those in which the patient is rechallenged with the drug; and those which exclude other possible causative factors (disease process, other drugs,

environmental agents). • Clinical photographs in context• Personal view• The patient that changed my practice

Confidentiality

If there is any chance that a patient may be identified from a case report, illustration, or paper ask for the written consent of the patient for publication. Patients are almost always willing to give such consent. Black bands across the eyes are wholly ineffective in disguising the patient, and changing details of patients to try to disguise them is bad scientific practice.

Instructions for authors, BMJ. Smith J. Keeping confidences in published papers. BMJ 1991;302:1168.

References• You must reference all facts which are not general knowledge (e.g.

temperatures in winter are usually lower than in summer) or your own ideas (textbooks and reviews suffice for well established facts)

• Not referencing material taken form or inspired by books, websites, personal communication, or reading of articles is plagiarism.

• If it is not your own idea, but you cannot remember where you got the information from non-referencing is still plagiarism. In this case chase reference or omit the statement.

• Vancouver style (http://www.nlm.nih.gov/bsd/uniform_requirements.html) follow instructions)

• Check references for style and spelling• Be consistent. e.g. do not use BMJ in one reference and British

Medical Journal in the next, either use all authors or abbreviated list, do not mix and match….

References

1. De Bakey and De Bakey. The case report. II. Style and form. Int J Cardiol1984;6:247-54.

2. Paper describing method: McCarthy, Family Medicine 2000. http://www.stfm.org/fmhub/Fullpdf/march00/fd2.pdf

3. Detailed instructions: Green et al 2000. http://www.usuhs.mil/studentresearch/WriteCaseReport.doc

4. ‘Systematic review of case reports’ Sorinola 2004 http://www.biomedcentral.com/1472-6920/4/4

5. Short Instructions for students http://www.usuhs.mil/studentresearch/WriteCaseReport.doc

6. Student BMJ instructions http://student.bmj.com/search/pdf/04/02/sbmj60.pdf

7. Vancouver reference style http://www.nlm.nih.gov/bsd/uniform_requirements.html