The clinical case report: a review of its merits and limitations

Abstract

BackgroundThe clinical case report has a long-standing tradition in the medical literature. While its scientific significance has become smaller as more advanced research methods have gained ground, case reports are still presented in many medical journals. Some scholars point to its limited value for medical progress, while others assert that the genre is undervalued. We aimed to present the various points of view regarding the merits and limitations of the case report genre. We searched Google Scholar, PubMed and select textbooks on epidemiology and medical research for articles and book-chapters discussing the merits and limitations of clinical case reports and case series.ResultsThe major merits of case reporting were these: Detecting novelties, generating hypotheses, pharmacovigilance, high applicability when other research designs are not possible to carry out, allowing emphasis on the narrative aspect (in-depth understanding), and educational value. The major limitations were: Lack of ability to generalize, no possibility to establish cause-effect relationship, danger of over-interpretation, publication bias, retrospective design, and distraction of reader when focusing on the unusual.ConclusionsDespite having lost its central role in medical literature in the 20th century, the genre still appears popular. It is a valuable part of the various research methods, especially since it complements other approaches. Furthermore, it also contributes in areas of medicine that are not specifically research-related, e.g. as an educational tool. Revision of the case report genre has been attempted in order to integrate the biomedical model with the narrative approach, but without significant success. The future prospects of the case report could possibly be in new applications of the genre, i.e. exclusive case report databases available online, and open access for clinicians and researchers.

Using the journal BMJ Case Reports to promote the publication of clinical case reports

“…3. CCRs as an avenue for sharing valuable clinical lessons: CCRs potentially have a high sensitivity for detecting novelty [4,5]. They serve as the first line of evidence [6] and can be powerful tools for discovering new diseases, unusual clinical syndromes, disease associations, and unusual side effects of therapy or responses to treatments [8,9].…”

“…CCRs have a long tradition in medical literature [3] and have been published as a regular section in many medical journals. However, the 1980s saw a rise in negative opinions of CCRs due to their low level in the hierarchy of evidence [4] and their lack of specificity for medical decision making [5]. Since the late 1990s, however, CCRs have been increasingly published, with the genre adapting to new challenges [5,6] and the launch of new journals specifically devoted to publishing CCRs.…”

Using the journal BMJ Case Reports to promote the publication of clinical case reports

“…Manuscript preparation and submission process: To strengthen the level of evidence of CCRs and satisfy editors' expectations, the quality of case reporting must be high, and authors must be careful not to generalize, overinterpret, or misinterpret their observations. For this reason, BMJ Case Reports requests a precise, focused primary message and a well-organized and structured report, submitted using a required manuscript template [5,10]. Both the patients' informed consent and their perspectives on their diseases or management are very important.…”

Case reports and case series versus modern evidence-based medicine: Merit for an individual patient and public health

“…Not representative and generalizability Anecdotal fallacy [21] Over interpretation and personal emotional aspect of the readers [4]. Biases Subjective Incomplete information from a retrospective in nature…”

“…Among non-experimental studies, case reports and case series are the most basic type of the study, but they are often the fundamental knowledge of all other types of non-experimental studies including case series, cross sectional, case-control, or cohort studies and experimental study like clinical trial [4] (Figure 1). …”