The Case for the Case Report

Abstract

Case reports at one time could be found in many if not most medical journals. I found that 40 years ago, the top 10 pediatric journals all published case reports (many with designated case report sections), and 30% of the articles published in the 10 journals collectively were case reports. Twenty years ago, these same journals had reduced their case report publications, averaging only 15% of their published articles, with many having dropped a case report section altogether. In 2016, case reports only accounted for 4% of articles published in this same group of journals, with Pediatrics at 11% being the most committed to this format of medical publication. Pediatrics also is the only one of these publications with a designated section for case reports. Pediatrics' recent decision to reduce the number of published case reports from a maximum of 8 an issue to 3 an issue is the latest in this long decline. It appears that 2 forces have had a role in the decline of the case report as a genre of medical publications. The 2 forces include the impact factor, created in the 1990s, and the inability to use statistical methodology to assess the data at hand. The impact factor is a measure of the frequency with which the average article in a journal has been cited from a particular year. It is used to measure the importance or rank of a journal by calculating the times its articles are cited. A 2-year period is used and involves dividing the number of times articles that were cited in that 2-year period after publication by the number of articles that are potentially citable. Case reports are handled, for this purpose, as are original articles. Case Reports, for reasons outlined below, are invariably not going to be cited as often as original articles by the 2-year postpublication period that defines the impact factor. The other force that has led to the decline of case reports is the inability to apply statistical analysis to strengthen the scientific merit of the report. In the words of one of my coeditors, "You can't tell anything from a single case." The error in this reasoning is the supposition that a case report and an original article have anything in common. They don't.

Chronicling Research and Practice Evolution in Pediatric Physical Therapy

“…Case reports allow researchers to study a child's complete medical history, diagnosis, and treatment and then generate inferences regarding the condition's overall prognosis and natural trajectory. Case reports in pediatrics are primarily used in the hypothesis testing phase of research studies to gain scientific data and encourage further experimental studies 22. The consistent use of descriptive studies may be attributed to many pediatric conditions remaining poorly understood by both researchers and health care practitioners.…”

“…Case reports in pediatrics are primarily used in the hypothesis testing phase of research studies to gain scientific data and encourage further experimental studies. 22 The consistent use of descriptive studies may be attributed to many pediatric conditions remaining poorly understood by both researchers and health care practitioners. Descriptive studies serve to increase understanding and awareness of aspects of the condition.…”

Reasons to Keep “Case Reports” Alive

“…Some ideas can be considered to keep CR "alive": 1) CR database should be a great idea already adopted for many journals, and 2) CR would be presented as Educational, Image, or Multimedia presentations. These two suggestions are attractive options and may be stimulate [3][4][5]9,10] .…”

Enduring support for the case report

“…So long as medicine develops, these observations and discoveries will keep coming; so long as this prevails, the rationale for the case report as a mechanism for little steps of paradigm shifting will endure, helping us to ‘slowly move from ignorance to insight’ . What they should not be is novelty for novelty's sake or an account of minor relevance that does not enhance one's learning or have potential for changing practice . For this reason, peer review of case reports is essential for making sure that they stand up to scrutiny in delivering a meaningful message and warrant the precious reading time afforded them by the journal's readership.…”

“…8 What they should not be is novelty for novelty's sake or an account of minor relevance that does not enhance one's learning or have potential for changing practice. 9 For this reason, peer review of case reports is essential for making sure that they stand up to scrutiny in delivering a meaningful message and warrant the precious reading time afforded them by the journal's readership. Similarly, adhering to structures for case reporting, such as the CAse REport (CARE) guidelines, 5,10 will ensure that there is as much concordance between reports and series as possible, enabling better amalgamation of information and the potential for systematic reviews of case reports.…”