What a case report is for
A case report describes the clinical course of one patient, or of a small number, in enough detail for others to learn from it. Case reports have a long history in medicine. They record rare diseases, unexpected responses to treatment, adverse effects, unusual presentations, new diagnostic approaches and the first signals of new conditions. They can generate hypotheses and alert clinicians to something that larger studies later confirm. Their strength is detail and timeliness, and their weakness is that they cannot establish how common something is or prove cause and effect.
Because of this, a good case report is selective about what it claims. It says what happened, describes it accurately, explains why it is worth reporting, and places it in the literature, without drawing conclusions beyond what a single case allows. It is also a report about a person, which brings obligations of privacy and consent that other papers do not have. The original research support service covers studies with groups of participants, and this service covers the case report and the small case series.
What the service includes
- Assessment of what makes the case worth reporting, and of the novelty against the existing literature.
- Structure following the CARE guideline: title, abstract, key learning points, patient information, clinical findings, timeline, diagnostic assessment, interventions, outcomes, discussion and patient perspective.
- Timeline, built from the clinical record and presented as a table or figure.
- Literature search and context, to show what is known and what the case adds.
- Consent and de-identification check, against the journal's rules.
- Editing for clarity, consistency and accuracy.
- Journal selection and submission materials, including the CARE checklist.
- Revision support in response to reviewers.
The CARE guideline
CARE, for case reports, is a reporting guideline developed through a consensus process to improve the completeness and transparency of case reports. It lists the items that a report should contain, in the order of a typical paper. The title identifies the report as a case report and names the focus. The abstract states the background, the case summary, and the conclusion or main lesson. The keywords help indexing. The introduction explains why the case is unusual. The patient information gives demographics, the main concerns and symptoms, and the relevant history, including family and psychosocial history and past interventions. The timeline shows the sequence of events. The clinical findings and the diagnostic assessment describe the examination, the tests, the reasoning, the challenges and the prognosis. The therapeutic intervention and the follow-up and outcomes are described, with attention to adherence and adverse events. The discussion places the case in the literature, with strengths and limitations, and states the take-away. The patient's perspective and the informed consent complete the report.
The guideline is a help and not a straitjacket: not every item applies to every case, but each omission should be a decision. A completed checklist is increasingly requested at submission. See reporting guidelines.
Consent, privacy and de-identification
A case report describes a real person, and the patient has a right to privacy. The ICMJE recommendations state that identifying information, including names, initials, hospital numbers and photographs, should not be published unless it is essential for scientific purposes and the patient, or a parent or guardian, has given written informed consent for publication. Many journals require a signed consent form or a statement that consent was obtained, and some require it even for reports that appear fully de-identified, because details such as a rare condition combined with age, place and dates can make a patient recognizable.
De-identification is more than removing a name. Dates are generalized, places and workplaces omitted, images cropped to remove identifying features, and details altered only where this does not change the science. Where a patient has died or cannot consent, the journal's policy for such cases applies, and ethics advice may be needed. Whether an ethics committee needs to review a case report varies by institution and country. The clinician is responsible for obtaining consent and for confirming that the report meets the rules of the journal and the institution, and we ask to see the evidence of consent before preparing the report for submission. We cannot support a case report for which consent is required and has not been obtained.
Is the case worth reporting?
Journals receive many case reports and publish a minority, so novelty and teaching value matter. A case is more likely to be of interest if it describes a new or rare condition or presentation, a previously unreported association, an unexpected response or adverse event, a diagnostic or therapeutic approach that was new or instructive, or a case that challenges a common assumption. A common presentation of a common condition, with a typical course, is rarely published. A literature search is the way of testing this: if similar cases have been reported, the new report needs to say how it differs or what it adds, and it may fit better as part of a case series or a short letter.
The search also provides the discussion with its context. A report that cites the existing cases, compares findings with them and explains what is new reads as a contribution. A report that has no context, or that cites only reviews, does not. The search methods described under search strategy development can be applied on a small scale.
Building the timeline
The timeline is one of the distinctive features of CARE, and it is often the most useful part of a case report to readers. It places the key events in order: the onset of symptoms, consultations, investigations, diagnoses, treatments with doses and durations, changes in the condition, complications and the outcome, each with its date or, for de-identification, its relative time from a reference point such as the first presentation. A table or a simple figure works equally well. Building it from the clinical record, and not from memory, forces the author to confirm the sequence and often reveals gaps, such as a test whose result is not documented, or a change of treatment with no clear reason. Those gaps should be filled or acknowledged, since reviewers notice when the sequence does not add up. The clinician checks the finished timeline against the record, as accuracy is their responsibility.
Images, results and supplementary material
Images, such as photographs, scans and pathology slides, can make a case report far more informative, and they raise the privacy issues described above. Photographs of faces or distinctive features need explicit consent, and may be better replaced or cropped. Radiology and pathology images should have identifying marks removed from the image itself, including from any embedded data. Figures should be of sufficient resolution and have legends that say what the reader is meant to see, with arrows or labels for the finding. Laboratory results are presented in a table with reference ranges and units. Some journals allow supplementary material such as video, which has the same consent requirements. All of this is checked against the journal's instructions before submission.
Writing the lesson
A case report should end with a clear take-away, and it should be modest. The conclusion should follow from the case, not from a general claim about disease or treatment. A report that describes a patient who improved after a treatment should not conclude that the treatment works. It can say that improvement was observed, describe the possible explanations including the natural course of the illness and other treatments, and suggest that further study is warranted. Overstatement is the commonest weakness of published case reports, and reviewers look for it. The honest statement of limitations, such as the single patient, the possibility of coincidence and the absence of a control, is part of the quality of the report and not a concession.
Case series
A case series reports several patients with a shared feature. It can describe the spectrum of a condition, the experience of a treatment or the frequency of an outcome among those treated at one center. A series raises further methodological points. The method of selecting the patients should be stated, since reporting only the interesting cases overstates what is typical. A denominator, when known, allows readers to see how the reported patients relate to all those seen. Descriptive statistics should be used to describe, and not to test hypotheses that the design cannot test. Where the series is large and has a consistent follow-up, it begins to resemble a cohort study, and the STROBE guideline may be more suitable than CARE. The choice of guideline follows the design.
Choosing a journal
Not all journals publish case reports, and policies differ. Some publish them in full, some only as short reports or letters, and some, including high-impact general journals, publish them rarely. Open-access journals dedicated to case reports exist, and their quality varies, so the same reputation checks apply as for any submission: indexing, transparency of peer review and fees. The journal's policy on consent, images and ethics approval affects what can be submitted. The considerations are described under publication support and in the guide to choosing a journal.
Deliverables
- Assessment of novelty and teaching value, with the literature found.
- Structured manuscript following CARE, including the timeline.
- Consent and de-identification check against the journal's rules.
- Completed CARE checklist.
- Journal shortlist and submission materials.
- Support with reviewer comments, where in scope.
Get a quoteTell us about the case in general terms, without identifying details.
Optional extension: full manuscript and submission
Full case report and submission package
When the scope includes writing up the case and submitting it, the package also contains the following.
Full case report manuscript
Structured by CARE, with the timeline and the discussion set in the context of the literature.
Consent and CARE checklist
Consent and de-identification checked against the journal's rules, and the checklist completed.
Submission package
A journal recommendation, the formatted manuscript, a cover letter and supplementary files.
Revision round
A point-by-point response to editor and reviewer comments.
Manuscript preparation follows the research integrity and authorship statement. The researchers who conceived the study and interpret its findings remain responsible for the content and its conclusions, and contributions that do not meet authorship criteria are acknowledged.
Limitations and boundaries
Case reports are low in the hierarchy of evidence, and no amount of good writing changes this. They cannot show that a treatment works or how often an event occurs, and conclusions should respect that. We do not create or alter cases, and we do not invent clinical details, timelines or outcomes. The treating clinician is responsible for the accuracy of every detail and for the patient's consent, and we work from the information that the clinician provides. We do not give clinical advice or opinions on the care of any patient, and nothing in a case report is a recommendation for treatment. Please do not send identifiable patient information through the contact form or in an enquiry. Acceptance by a journal cannot be guaranteed.
This service provides research and publication support. It does not provide clinical advice. Do not send identifiable patient information in an enquiry.
How long does it take?
The time depends on how complete the clinical record is, whether consent is already in place, how much literature there is to review and how many journals are tried. A well-documented case with consent in hand can be prepared quickly, and a case that needs a literature search, a timeline reconstructed from records and consent to be obtained takes longer. Tell us the target journal and any deadline at the start.
Frequently asked questions
Do I need the patient's consent to publish a case report?
In most cases, yes. The ICMJE recommendations require written informed consent for publication of identifying information, and many journals require consent even when a report appears de-identified. The journal's policy and your institution's rules apply.
Is removing the patient's name enough to de-identify a case?
No. Dates, places, rare conditions, images and other details can make a patient recognizable. De-identification also covers these, while keeping the scientific content accurate.
What is the CARE guideline?
CARE is a reporting guideline for case reports that lists the items a report should include, such as the timeline, the diagnostic assessment, the interventions, the outcomes and the patient's perspective. Many journals ask for a completed checklist.
Is my case interesting enough to publish?
A literature search helps to decide. Cases that describe something new, rare, unexpected or instructive are more likely to be accepted, while typical presentations of common conditions seldom are.
Can you write a case report without the clinician's data?
No. The case must come from the treating clinician's records, and we do not create or alter clinical details. The clinician is responsible for accuracy and consent.
Can I send patient details through the contact form?
Please do not. Describe the case in general terms and we will explain how to share information securely.
References
- Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. J Clin Epidemiol. 2014;67(1):46-51.
- Riley DS, Barber MS, Kienle GS, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218-235.
- International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. Section on protection of research participants and patient privacy. Available at icmje.org (check the current version).
- Committee on Publication Ethics. Core Practices. Available at publicationethics.org.
- Nissen T, Wynn R. The clinical case report: a review of its merits and limitations. BMC Res Notes. 2014;7:264.
- Vandenbroucke JP. In defense of case reports and case series. Ann Intern Med. 2001;134(4):330-334.
- EQUATOR Network. Enhancing the QUAlity and Transparency Of health Research. Available at equator-network.org.
- von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335:806-808.