# Case report

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{{Short description|Detailed medical report on a patient}}
In [medicine](/source/medicine), a '''case report''' is a detailed report of the [symptom](/source/symptom)s, [sign](/source/medical_sign)s, [diagnosis](/source/diagnosis), treatment, and follow-up of an individual [patient](/source/patient). Case reports may contain a [demographic profile](/source/demographic_profile) of the patient, but usually describe an unusual or novel occurrence. Some case reports also contain a [literature review](/source/literature_review) of other reported cases. Case reports are professional narratives that provide feedback on clinical practice guidelines and offer a framework for early signals of effectiveness, [adverse events](/source/Adverse_effect), and cost. They can be shared for medical, scientific, or educational purposes.

== Types ==
Most case reports are on one of six topics:<ref>{{cite book |author1=Debra Volkland |author2=Robert L. Iles |title=Guidebook to better medical writing |publisher=Island Press |location=Washington, DC |year=1997 |isbn=978-0-9661831-0-8 |oclc=41579709 }}</ref>

* An unexpected association between [disease](/source/disease)s or [symptom](/source/symptom)s.
* An unexpected event in the course of observing or treating a patient.
* Findings that shed new light on the possible [pathogenesis](/source/pathogenesis) of a disease or an adverse effect.
* Unique or rare features of a disease.
* Unique therapeutic approaches.
* A positional or quantitative variation of the anatomical structures.

== Roles in research and education ==
A case report is generally considered a type of [anecdotal evidence](/source/anecdotal_evidence).<ref>{{cite journal | author=Aronson JK | title=Anecdotes as evidence | journal=BMJ |volume=326 |issue=7403 |page=1346 |date=June 2003  | pmid=12816800 | pmc=1126236 | doi=10.1136/bmj.326.7403.1346 }}</ref>  Given their intrinsic [methodological](/source/methodological) limitations, including lack of [statistical sampling](/source/statistical_sampling), case reports are placed at the bottom of the [hierarchy of clinical evidence](/source/hierarchy_of_evidence), together with [case series](/source/case_series).<ref name=Greenhalgh-HowToRead>{{cite journal |author=Greenhalgh T |title=How to read a paper. Getting your bearings (deciding what the paper is about) |journal=BMJ |volume=315 |issue=7102 |pages=243–6 |date=July 1997  |pmid=9253275 |pmc=2127173 |doi= 10.1136/bmj.315.7102.243}}</ref> Nevertheless, case reports do have genuinely useful roles in [medical research](/source/medical_research) and [evidence-based medicine](/source/evidence-based_medicine).<ref name=Gagnier2013>{{cite journal |vauthors=Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D |title=The CARE guidelines: consensus-based clinical case reporting guideline development |journal=Headache |volume=53 |issue=10 |pages=1541–7 |year=2013 |pmid=24266334 |doi=10.1111/head.12246 |pmc=3784031 }}</ref> In particular, they have facilitated recognition of new diseases and adverse effects of treatments.<ref name=Aronson2006>{{cite journal |vauthors=Aronson JK, Hauben M |title=Anecdotes that provide definitive evidence |journal=BMJ |volume=333 |issue=7581 |pages=1267–9 |date=December 2006  |pmid=17170419 |pmc=1702478 |doi=10.1136/bmj.39036.666389.94 }}</ref> For example, the recognition of the link between administration of [thalidomide](/source/thalidomide) to mothers and malformations in their babies was triggered by a case report.<ref>{{cite web |url=http://www.jameslindlibrary.org/illustrating/articles/thalidomide-an-unanticipated-adverse-effect |title=Thalidomide and congenital abnormalities |publisher=James Lind Library | access-date=28 May 2014}}</ref> Case reports have a role in [pharmacovigilance](/source/pharmacovigilance).<ref name=Aronson2006/> They can also help understand the clinical spectrum of [rare diseases](/source/rare_diseases) as well as unusual presentations of common diseases.<ref name=Gagnier2013/> They can help generate study [hypotheses](/source/hypotheses), including plausible [mechanisms of disease](/source/pathogenesis).<ref name=Gagnier2013/> Case reports may also have a role to play in guiding the [personalization](/source/Personalized_medicine) of treatments in clinical practice.<ref name=Gagnier2013/>

Proponents of case reports have outlined some particular advantages of the format. Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress; they provide many new ideas in medicine.<ref>{{cite journal |author=Vandenbroucke JP |title=In defense of case reports and case series |journal=Ann. Intern. Med. |volume=134 |issue=4 |pages=330–4 |date=February 2001 |pmid=11182844 |doi= 10.7326/0003-4819-134-4-200102200-00017|s2cid=867759 }}</ref> Whereas [randomized clinical trial](/source/randomized_clinical_trial)s usually only inspect one variable or very few variables, rarely reflecting the full picture of a complicated medical situation, the case report can detail many different aspects of the patient's [medical](/source/medicine) situation (e.g. [patient history](/source/patient_history), [physical examination](/source/physical_examination), [diagnosis](/source/diagnosis), [psychosocial](/source/psychosocial) aspects, follow up).<ref name="Yitschaky, 2011">{{cite journal |vauthors=Yitschaky O, Yitschaky M, Zadik Y |title=Case report on trial: Do you, Doctor, swear to tell the truth, the whole truth and nothing but the truth? |journal=J Med Case Rep |volume=5 |issue=1 |page=179 |date=May 2011 |pmid=21569508 |url=http://www.jmedicalcasereports.com/content/pdf/1752-1947-5-179.pdf|doi=10.1186/1752-1947-5-179 |pmc=3113995 |doi-access=free }}</ref>

Because typical, unremarkable cases are less likely to be published, use of case reports as scientific evidence must take into account [publication bias](/source/publication_bias). Some case reports also contain an extensive review of the relevant literature on the topic at-hand (and sometimes a [systematic review](/source/systematic_review) of available evidence). Reports adopting this sort of approach can be identified by terms such as a "case report and review of the literature". Reports containing broader active research such as this might be considered [case studies](/source/case_studies) in the true definition of the term.

Case reports can also play a relevant role in medical education by providing a structure for [case-based](/source/Case-based_reasoning) learning.<ref name=Gagnier2013/>

A particular attraction of case reports is the possibility of quick publication (with respect to more extensive studies such as randomized control trials), allowing them to act as a kind of rapid short communication between busy clinicians who may not have the time or resources to conduct large scale research.<ref name="Yitschaky, 2011"/>

== Reporting guidelines ==
The quality of the scientific reporting of case reports is variable, and sub-optimal reporting hinders the use of case reports to inform research design or help guide clinical practice.<ref name=Gagnier2013/> In response to these issues, reporting guidelines are under development to facilitate greater transparency and completeness in the provision of relevant information for individual cases.<ref name=Gagnier2013/> The CARE (i.e. CAse REport) guidelines include a reporting checklist that is listed on the [EQUATOR Network](/source/EQUATOR_Network),<ref name=EQUATOR>{{cite web |url=http://www.equator-network.org/reporting-guidelines/care/ |title=The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development | publisher=The EQUATOR Network |access-date=2014-05-28}}</ref> an international initiative aimed at promoting transparent and accurate reporting of health research studies to enhance the value and reliability of medical research literature. This 13-item checklist includes indications regarding the title, key words, [abstract](/source/abstract_(summary)), introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and [informed consent](/source/informed_consent).<ref name=Gagnier2013/> An explanation and elaboration article (a manual for writing case reports following the CARE guidelines) was published in the Journal of Clinical Epidemiology in 2017.<ref>{{Cite journal|last1=Riley|first1=David S.|last2=Barber|first2=Melissa S.|last3=Kienle|first3=Gunver S.|last4=Aronson|first4=Jeffrey K.|last5=von Schoen-Angerer|first5=Tido|last6=Tugwell|first6=Peter|last7=Kiene|first7=Helmut|last8=Helfand|first8=Mark|last9=Altman|first9=Douglas G.|date=September 2017|title=CARE guidelines for case reports: explanation and elaboration document|journal=Journal of Clinical Epidemiology|volume=89|pages=218–235|doi=10.1016/j.jclinepi.2017.04.026|pmid=28529185|s2cid=205846029 }}</ref>

== Publishing ==
{{See also|Category:Case report journals}}
Many international journals publish case reports, but they restrict the number that appear in the print run because this has an adverse effect on the journal's [impact factor](/source/impact_factor).<ref name=Howto/> Case reports are often published online, and there is often still a [requirement for a subscription](/source/paywall) to access them. However, an increasing number of journals are devoted to publishing case reports alone, most of which are [open access](/source/open_access).<ref>{{Cite journal|last=Akers|first=Katherine G.|date=2016-11-21|title=New journals for publishing medical case reports|journal=Journal of the Medical Library Association|volume=104|issue=2|pages=146–149|doi=10.5195/jmla.2016.62|issn=1558-9439|pmc=4816468|pmid=27076803}}</ref><ref name=Howto>{{Cite journal|last1=Rison|first1=Richard A.|last2=Shepphird|first2=Jennifer Kelly|last3=Kidd|first3=Michael R.|date=2017-07-22|title=How to choose the best journal for your case report|journal=Journal of Medical Case Reports|volume=11|issue=1|page=198|doi=10.1186/s13256-017-1351-y|issn=1752-1947|pmc=5522590|pmid=28732524 |doi-access=free }}</ref> The first of these to start publishing, in 2001, was ''[Grand Rounds](/source/Grand_Rounds_(journal))''.<ref>{{Cite journal |pmc = 338152|year = 2004|last1 = Bognolo|first1 = G.|title = Grand Rounds|journal = BMJ: British Medical Journal|volume = 328|issue = 7435|page = 353|doi = 10.1136/bmj.328.7435.353-a}}</ref><ref>{{cite web |url=http://www.grandroundsjournal.com/ |title=Online open peer-reviewed case report journal  |work=Grand Rounds }}</ref>

There are a number of websites that allow patients to submit and share their own patient case reports with other people. [PatientsLikeMe](/source/PatientsLikeMe)<ref>{{cite web |url=http://www.patientslikeme.com |title=Treatment and Side Effect Information |work=Patients Like You }}</ref> and Treatment Report<ref>{{cite web |url=http://www.treatmentreport.com |title=Share and Find Treatment Reviews for Medical Conditions |work=Treatment Report |archive-url=https://web.archive.org/web/20160729205207/http://www.treatmentreport.com/# |archive-date=2016-07-29 }}</ref> are two such sites.

== Use of terminology outside science  ==
The term is also used to describe non-scientific reports usually prepared for educational reasons.

== Famous scientific case reports ==
* [Sigmund Freud](/source/Sigmund_Freud) reported on numerous cases, including [Anna O.](/source/Anna_O.), [Dora](/source/Dora_(case_study)), [Little Hans](/source/Oedipus_complex), [Rat Man](/source/Rat_Man), and [Wolf Man](/source/Sergei_Pankejeff)
* [Frederick Treves](/source/Sir_Frederick_Treves%2C_1st_Baronet) reported on "[The Elephant Man](/source/Joseph_Merrick)"
* [Paul Broca](/source/Paul_Broca) reported on language impairment following left hemisphere lesions in the 1860s.
* [Joseph Jules Dejerine](/source/Joseph_Jules_Dejerine) reported on a case of [pure alexia](/source/pure_alexia).
* [William MacIntyre](/source/William_MacIntyre) reported on a case of [multiple myeloma](/source/multiple_myeloma) (described in the 1840s).
* [Christiaan Barnard](/source/Christiaan_Barnard) described the world's first [heart transplant](/source/heart_transplant)<ref>{{cite web |url=http://www.grandrounds-e-med.com/articles/grHist-001.htm |title=Cardiac transplantation: since the first case report |work=Grand Rounds |archive-url=https://web.archive.org/web/20101023181415/http://www.grandrounds-e-med.com/articles/grHist-001.htm |archive-date=2010-10-23 }}</ref> as a case report
* W. G. McBride, Thalidomide Case Report (1961). ''The Lancet'' 2:1358.

== See also ==
* [Case series](/source/Case_series)
* [Case presentation](/source/Case_presentation)

== References ==
{{reflist|2}}
* {{cite journal | author = Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T | display-authors = etal | year = 2017 | title = CARE 2013 Explanation and Elaborations: Reporting Guidelines for Case Reports | journal = Journal of Clinical Epidemiology | volume = 89 | pages = 218–235 | pmid = 28529185 | doi = 10.1016/j.jclinepi.2017.04.026 | s2cid = 205846029 }}

== Further reading ==
* {{cite journal |url=http://student.bmj.com/student/view-article.html?id=sbmj.b5274 |title=Writing a medical case report |last1=Jamjoom |first1=Aimun |last2=Nikkar-Esfahani |first2=Ali |last3=Fitzgerald |first3=J Edward |journal=BMJ |volume=340 |article-number=b5274 |doi=10.1136/sbmj.b5274 |year=2010 |s2cid=164945175 |url-access=subscription }}
* {{cite journal|last1=Kidd|first1=Michael|last2=Hubbard|first2=Charlotte|title=Introducing Journal of Medical Case Reports|journal=Journal of Medical Case Reports|volume=1|issue=1|year=2007|page=1|issn=1752-1947|doi=10.1186/1752-1947-1-1|pmid=17411446|pmc=1839763 |doi-access=free }}
* {{cite journal|last1=Richardson|first1=Michael L.|last2=Chew|first2=Felix S.|title=Radiology Case Reports: a new peer-reviewed, open-access journal specializing in case reports|journal=Radiology Case Reports|volume=1|issue=1|pages=1–3|year=2006|issn=1930-0433|doi=10.2484/rcr.v1i1.7|pmid=27298670|pmc=4891400}}
* {{cite web |url=http://www.radiologycases.com/index.php/radiologycases/article/view/1 |title=Talanow: A new interactive Radiology journal |archive-url=https://web.archive.org/web/20080927052206/http://www.radiologycases.com/index.php/radiologycases/article/view/1 |archive-date=2008-09-27 }}

== External links ==
* [https://web.archive.org/web/20190706173318/http://www.care-statement.org/index.html Case reports – The CARE guidelines]

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Adapted from the Wikipedia article [Case report](https://en.wikipedia.org/wiki/Case_report) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Case_report?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.