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
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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
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Cases that report hitherto unknown or unreported diseases, combination of
symptoms, presentations, side effects of drugs, or treatments
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Cases that contribute to a change in the course of medical science
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Small case series
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Cases which contradict current knowledge and generate new ideas and
hypotheses
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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 II
Check case report for
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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
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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
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Use spell checker
Proof read after spell checking to weed out errors introduced during spellcheck
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
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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.
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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
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…..
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).
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).
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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
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De Bakey and De Bakey. The case report. II. Style and form. Int J
Cardiol1984;6:247-54.
Paper describing method: McCarthy, Family Medicine 2000.
http://www.stfm.org/fmhub/Fullpdf/march00/fd2.pdf
Detailed instructions: Green et al 2000.
http://www.usuhs.mil/studentresearch/WriteCaseReport.doc
‘Systematic review of case reports’ Sorinola 2004
http://www.biomedcentral.com/1472-6920/4/4
Short Instructions for students
http://www.usuhs.mil/studentresearch/WriteCaseReport.doc
Student BMJ instructions
http://student.bmj.com/search/pdf/04/02/sbmj60.pdf
Vancouver reference style
http://www.nlm.nih.gov/bsd/uniform_requirements.html