Year : 2021 | Volume
: 64 | Issue : 4 | Page : 631--632
Are case reports losing their impact?
Professor & Head, Department of Pathology, Rajshree Medical Research Institute, Bareilly, Uttar Pradesh, India
MD; FIC Path; MIAC, DHA Ranjan Agrawal
Professor & Head, Department of Pathology, Rajshree Medical Research Institute, Bareilly, Uttar Pradesh
|How to cite this article:|
Agrawal R. Are case reports losing their impact?.Indian J Pathol Microbiol 2021;64:631-632
|How to cite this URL:|
Agrawal R. Are case reports losing their impact?. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Nov 27 ];64:631-632
Available from: https://www.ijpmonline.org/text.asp?2021/64/4/631/328589
Case reports (CR) have always been the first step towards any research pedigree. CR describe the unique aspects of a patient providing a clear, clinical and educational significance in medical science. They continue to provide a novel and new knowledge of rare entities, syndromes, newer diagnostic modalities, specific images, unusual clinico-pathological relations, and surgical interventions as long as they are scientifically correct. They represent one of the oldest levels of evidence but recently they have attracted much criticism, probably due to low citations and also because of the drastic reduction in their numbers in journals with a good impact. The long-term adverse consequence of fetal exposure to diethylstilbestrol in pregnancy was known to the World after publication of the cases, thus issuing strong warnings against the use of this teratogenic drug. Besides, discovery of new diseases such as acquired immune deficiency syndrome (AIDS), severe acute respiratory syndrome (SARS), and swine flu began with the report of a single case adding knowledge to the existing database in the era of evidence-based medicine.,, Reports of the first face transplant and first uterine transplant were presented as single cases, with the readers learning more about the methodological difficulties, immunological factors, and ethical dilemmas.
CR represent the basic form of clinical research classified under observational or descriptive trials. Our current knowledge about any disease begins with CR. Dating back to the earlier years of Hippocrates (400 BC), CR with detailed clinical findings started increasing in numbers with a strong emphasis on the chronological order of the occurrence of the disease and its evolution, including the etiopathogenesis, since at that time these pathologies were considered to be due to supernatural causes. Later, during the 19th century, a modified system was adopted, wherein scientific language was adopted and the text was subdivided into various sections. However, the patient's perspective was still missing from the text. CR then became the first step in student learning process of scientific writing, along with the development of communication skills. With the onset of evidence-based medicine CR slipped down to the lowest category of research design, probably due to their inability to control biases, chance findings, non-reproducibility, and limited conclusions. CR are usually not standardized and their quality may vary. There were no available uniform guidelines for CR until September 2013, when the international reporting guidelines for case reports (CARE) was created. CARE was designed with the intention of increasing the efficacy, clarity, and utility of publishing CR. The beneficiaries of these guidelines included patients, clinicians, researchers, educators, authors as well as members of the editorial board. Patients could opine into the treatment part; clinicians into the comparative analysis; researchers into evidence-based hypotheses, educators into the hypothesis part, and authors and editors into the article framework. In 1920, Sir William Osler, the father of modern medicine, stated: “Always note and record the unusual ... Publish it. Place it on a permanent record as a short, concise note. Such communications are always of value.”
Double blind, use of control groups, and other randomized clinical trials have been the landmarks in the advancement of scientific knowledge. Use of case histories in medicine has been an important tool in the advancement of clinical knowledge. Previously published cases are helpful for teaching purposes. It is a medium by which the researcher and faculty may record their thoughts and observations in arriving at a diagnosis or providing an explanation to the rationale behind an innovative therapy. CR carry an important role in generating new research and hypotheses. The clubbing together of different CR of similar type allows for comparison and generation of hypotheses for further testing. Conclusions drawn from these reports can then further be reaffirmed or reassessed via clinical trials or researches providing an important baseline for future research.
CR usually document episodes in the early emerging phase or during small outbreaks. Although they are considered weak evidence in medical literature, CR forms the first report when there is a new emerging infectious disease. A complete research on such diseases usually takes a long time to perform and still more time for publication of the results to take place. The recommendation for treatment is usually set on the basis of the clinical information that is usually derived from published CR. CR can provide useful information and base for further case series, reviews, or researches. CR usually does not carry high scientific merit when compared to the well-designed, randomized clinical trials or meta-analyses. However, if they are well reviewed and screened before publication, CR can be reliable to much extent.
CR usually incorporate a variety of experiences from personal practices and writing of patient's case. On the contrary, randomized clinical trials provide answer for a specified clinical question and have an impact on future results, whereas CR influence today's practice and provide details regarding different aspects of patient's medical condition that were missed or remained undetected., Variations in the anatomical structures, hypothesis regarding the pathogenesis of a disease, unexpected association between disease and symptoms are other aspects covered by CR, but not by clinical trials.
Academic skill, clinical knowledge, and creative writing all help to attract the attention of an editor to publish a report and the readers to read it. Some barriers with CR observed include: lack of standard guidelines or norms, limited access to reference materials, journal overload, and language barriers, thus making it difficult to publish CR in journals with a high impact factor or carry a financial burden to publish in journals with article processing charges. A possible solution may be teaching postgraduates the importance of writing CR from the early stages of their training, honing their writing abilities, and thus providing a critical experience of peer review process. Inspite of all odds, CR constitute valuable resources of unusual information that may lead to new research and advances in clinical practice.
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