Case reports are very frequent form of medical publication. Case reports in surgery describe a patient’s surgical condition and surgical management, and are intended for educational or scientific purposes. These help identify rare or new diseases, assessing the beneficial or adverse effects of interventions, and aiding medical education. Any kind of scientific writing like case reports in surgery, case series in surgery and surgery review articles requires adhering to specific guidelines. Case reports in surgery or in any other medical or surgical speciality need to go by the CARE guidelines.
CARE is the abbreviation of Case Reports. These are guidelines developed and provided by an international team of professionals to ensure usefulness, transparency, and accuracy of case reports.
These recommendations were first developed in 2011-2012, and presented in 2013 at the International Congress on Peer Review and Biomedical Publication. Soon, they were endorsed by various medical journals, and translated into nine languages.
The care guidelines for case reports seek to improve health research reporting and hence support the mission of Equator Network, an international initiative aimed at enhancing the reliability and value of medical research literature.
Transparent and accurate collection and reporting of data from medical care episodes enables the delivery of high-quality individualized healthcare in the future. CARE guidelines for case reports facilitate authors to increase transparency, lower chances of bias, and provide info on what works, under what circumstances, and for which patients. CARE guidelines are applicable to case reports in in surgery and case reports in any other medical or surgical speciality
Thus, CARE guidelines let authors know how to write a good case report. Well-written and straightforward case reports developed as per CARE guidelines disclose early signals of possible merits, demerits and other info on the use of resources, give directions for clinical practice and clinical research, and facilitate better medical education
Case reports in speciality of surgery written as per CARE guidelines facilitate the evaluation of patient and clinician assessed outcomes, efficiency of Clinical Practice Guidelines (CPGs), and the returns on investment (ROI).
Surgical case reports written in accordance to Care guidelines would benefit healthcare stakeholder categories including-
Surgical case reports written in accordance to CARE guidelines would benefit healthcare stakeholder categories including-
Patients- for examining and comparing the available therapeutic options.
Educators- by aiding case-based learning.
Researchers- in coming up with testable hypotheses from clinical settings.
Authors- by simplifying the process of writing systematic, transparent, and accurate case reports.
Medical Journals- by assisting “author guidelines’ and peer review of International Journals like Journal of Case Reports and Images in Surgery
A. An Overview
Here is an overview of how to write a case report in surgery or in any other speciality for publication for a journal such as Journal of Case Reports and Images in Surgery.
First you need to choose an original case that hasn’t been previously reported and recognize the message you are interested in conveying to the audience. It can be about a diagnostic evaluation, an outcome, a rare or new disease, an intervention, a new perspective of case which poses a therapeutic or diagnostic challenge or something else.
Next, you need to collect the necessary information to precisely pen down the event as a narrative and as a timeline. Before writing the narrative part, you should create a timeline of your case report. It should be a summary of the things that happened in the case concerned.
After that, you should complete the remaining portion of the case report by including specialty-specific information with apt scientific explanations and references. Wherever possible, you should support outcomes by referring to the historic and scientific literature. Finally, write the abstract of your case report.
There is one important thing you need to do before you start writing a medical case report. It is, obtaining the informed consent of the patient whose medical case report you are about to submit to a journal. Also make sure that you de-identify the concerned patient’s information in your case report.
B. Case report writing sequence
Scientific writing isn’t hard if you know the writing sequence. Here is info on how to write a surgical case report with the right sequence
Section 1- Working Title, the Event: Timeline and Narrative
Title: Come up with a descriptive and concise working title that describes the most significant part of the event. It may be the symptom, diagnostic test, diagnostic intervention, or outcome. The primary focus should be succeed by the words “case report”.
Patient information: Collect the clinical information of the patient’s visits. De-identify his/her information. Pen down the patient’s primary medical conditions and major clinical findings; and his or her family, medical, and psychological history.
Timeline: Create a timeline to record what exactly happened along with the summary of episodes of medical care provided.
Event: Narrate the episode of care. Include figures and tables wherever required.
Complaints: The principal complaints and associated demographic details.
Clinical findings: Describe the concerned past medical history, suitable co-morbidities, and vital findings from physical examination (PE).
Diagnostic evaluations: Talk about diagnostic testing methods and results. Include the differential diagnosis, diagnostic challenges, diagnosis, and prognostic characteristics, when applicable.
Therapeutic interventions: Recount the intervention types (such as lifestyle, preventive, surgical, and pharmacologic); the administration of interventions (dosage, strength, frequency, and duration); and the modifications in therapeutic interventions, if any, along with explanations. You may include figures and tables to enhance clarity.
Investigation and results: Relate the clinical course of the care episodes during re-examination visits. Discuss the intervention discontinuation, interruption, or modification; intervention observance and tolerability and how it was evaluated; and unexpected events or adverse impacts.
Section 2- The Why’s: Introduction, Discussion, Conclusion
Here are CARE case report guidelines concerning the descriptions and discussions to be done in various sections of your surgery case reports.
Introduction: The introduction should shortly sum up why the case report is important and specify the most recent CARE article.
Rationale: Discuss why it might have happened. Relate your case’ argument by including its strengths and constraints with scientific references. That is, with a comprehensive review of literature.
Conclusion: The conclusion (generally written in a single paragraph), should include the chief findings from the case without references. In other words, it should include the major “take-away” of your case report.
Section 3- Abstract, Keywords, References, Acknowledgements, and Informed Consent
So, here is what you need to write when it comes to particulars relating to abstract, keywords, references, acknowledgements, and informed consent.
Abstract: You should write your abstract after you have completed writing your surgery case reports. It can be either structured (in the format: Introduction, Case Report, and Conclusion) or unstructured. Crisply outline the concerned details without citations. There should be details of the background, chief points from the case, and principal lessons to be acquired from the case report.
Keywords: Give 2 to 5 keywords that will recognize the vital concepts covered by the case report.
References: This section should include the apt references to your case report from scientific literature.
Acknowledgements: In this section, include a concise acknowledgement of funding support or conflicts of interest, if applicable.
Informed consent and Patient perspective: Authors should obtain informed consent (including a patient perspective) from the patient. It would be wise to ask for the patient’s informed consent and perspective before you start writing your case report. If the journal to which you are trying to submit your case report requests for this info, you should provide it. There are some journals that have consent forms which must be used irrespective of the obtained informed consents. And in rare cases, an additional approval such as one from ethics commission or IRB (Institutional Review Board) may be required. It should also include his/her perspective on the received treatment(s).
Appendices: If the journal that you are submitting your case report to requires the Appendices section, do include it in your case report.
C. CARE checklist case report.
Once you complete writing your case report, ensure that you have included the following in your case report.