How to write a case report

1
How to write a case report

• C. Roffe

2
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

3
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.

4
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
5
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.

6
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

7
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

8
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.

9
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 Cardiol19846247-54.
10
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 Cardiol19846247-54.
11
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 Cardiol19846247-54.
12
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 Cardiol19846247-54.
13
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.

14
Spelling

• Use spell checker
• Proof read after spell checking to weed out
  errors introduced during spell-check
• Check capitals/ lower case
• Drugs generic name LC (e.g. furosemide), trade
  name UC (e.g. Lasix)
• Diseases LC unless personal name e.g.
  Parkinsons 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

15
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..

16
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)

17
Common pitfalls

• Emotional and judgemental language
• interesting
• surprising
• unfortunately
• Putting persons before facts
• Then 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..

18
Publication types

• Lesson 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 puzzle
• These 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).

19
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

20
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.grandround
  s-e-med.com
• Journal of Medical Case reports (open access)
  http//www.jmedicalcasereports.com/

21
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

22
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 19913021168.

23
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/unifor
  m_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.

24
References

1. De Bakey and De Bakey. The case report. II. Style
   and form. Int J Cardiol19846247-54.
2. Paper describing method McCarthy, Family
   Medicine 2000. http//www.stfm.org/fmhub/Fullpdf/m
   arch00/fd2.pdf
3. Detailed instructions Green et al 2000.
   http//www.usuhs.mil/studentresearch/WriteCaseRepo
   rt.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/WriteCaseRepo
   rt.doc
6. Student BMJ instructions http//student.bmj.com/se
   arch/pdf/04/02/sbmj60.pdf
7. Vancouver reference style http//www.nlm.nih.gov/b
   sd/uniform_requirements.html