- Email: [email protected]
Whither the case report?
Journal of Infection (2008) 57, 93e94
www.elsevierhealth.com/journals/jinf
Whither the case report? Peter Moss Department of Infection and Tropical Medicine, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Castle Road, Cottingham, East Riding of Yorkshire, Hull HU16 5JQ, UK Accepted 24 April 2008 Available online 26 June 2008 Doctors have always relied on clinical anecdote and relayed experience to learn, and to improve their practise. Seminal early medical texts such as the Chinese Yellow Emperor’s Classic, the Ancient Egyptian Smith Papyrus, and Hippocrates’ Aphorisms, all expound methods based on the authors’ personal cases. Right down to the present day senior clinicians regale their juniors with examples of unusual or interesting diagnoses that they have made. The case report, in the form that we recognise today, formed an important part of early medical journals long before editors worshipped at the altar of evidence-based medicine. Now, however, it is widely believed that the case report has had its day. Practise cannot be based on a single case, or on small and non-significant series. We must look elsewhere for guidance: to the basic scientist to unlock the molecular mechanisms of disease, and to the organisers of randomised placebo-controlled trials to tell us how best to manage patients. If the latter prove inconclusive there are always meta-analyses and systematic reviews. Any truly scientific 21st century medical journal must surely focus on these gold standard studies, and there is little role for the odd and unusual clinical case report. For editors there are other considerations. They want to publish work of the finest quality. Authors prefer to submit their best work to journals with the highest impact factors, and these are derived from a calculation which includes the number of citations made to articles in the journal. In terms of attracting citations, case reports tend to be at the bottom of the pile, and therefore it may not be in the longterm interest of any ambitious biomedical journal to include them in the running order.
E-mail address: [email protected] (Editorial Office). 0163-4453/$34 doi:10.1016/j.jinf.2008.04.007
But perhaps we should not be too quick to dismiss these vignettes. Undoubtedly many case reports are submitted more in the hope of padding out a thin Curriculum Vitae rather than with any intention of expanding scientific knowledge. ‘‘The first case of Bacillus malignus infection in Ruritania’’ (when it is a common pathogen in other nearby countries) is of little interest to the wider world, while it is a surprisingly common belief that just because the author has never seen a particular condition before it must be sufficiently rare as to warrant a paper. The ‘‘case report and review’’ is another common phenomenon: a condition that has been reported frequently enough to not need reporting again, but is too infrequent for any meaningful conclusions to be drawn by briefly summarising the other published cases. On the other hand case reports can serve valuable functions. In the field of infection the first evidence of a genuinely important new organism or infection may be a single case report, and valuable insight into emerging pathogens can appear in this form. Similarly the first evidence of a rare but important adverse drug event may come not from the limited experience of premarketing trials but from a clinical case report once the agent is in wider use. Scientific observations in a single case may not prove anything in themselves, but when presented to a wider audience may trigger larger and more significant studies. Some infections will always be so rare that the only information comes from the anecdotal experience of others: this may not be rigorously evidence-based, but it is much better than no guidance at all. Last but by no means least case reports can entertain and interest, leavening worthy but dry pages of statistical analysis or molecular methods with some real clinical medicine. We believe the readership of the Journal of Infection enjoys reading
94 case reports, and would regret their omission completely from the Journal. Currently JOI receives about 40 case reports each month, of which 95% are rejected. Very few of the latter are bad, and many make reasonably interesting reading, but they do not meet the necessary criteria to warrant publication. Rather than ceasing to publish case reports altogether the Journal would like to provide a showcase for top quality papers, presenting truly original and important work. We therefore propose to continue to publish the best and most original case reports, but will limit this normally to a single paper each month, published in the printed
P. Moss version of the Journal to ensure maximum exposure. It is difficult, given the diverse nature of case reports, to state absolute criteria for acceptance. However, to be considered for publication the paper should fulfil one (or more) of the objectives discussed above. It is helpful if authors explain in their covering letter exactly why they think that their case report is of sufficient interest to be considered. The paper should be well written, and presented ready for publication in an English language journal. Articles should be no longer than 2000 words in length but can include up to three figures or data tables. And please.no more cases of Austrian’s syndrome!
www.elsevierhealth.com/journals/jinf
Whither the case report? Peter Moss Department of Infection and Tropical Medicine, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Castle Road, Cottingham, East Riding of Yorkshire, Hull HU16 5JQ, UK Accepted 24 April 2008 Available online 26 June 2008 Doctors have always relied on clinical anecdote and relayed experience to learn, and to improve their practise. Seminal early medical texts such as the Chinese Yellow Emperor’s Classic, the Ancient Egyptian Smith Papyrus, and Hippocrates’ Aphorisms, all expound methods based on the authors’ personal cases. Right down to the present day senior clinicians regale their juniors with examples of unusual or interesting diagnoses that they have made. The case report, in the form that we recognise today, formed an important part of early medical journals long before editors worshipped at the altar of evidence-based medicine. Now, however, it is widely believed that the case report has had its day. Practise cannot be based on a single case, or on small and non-significant series. We must look elsewhere for guidance: to the basic scientist to unlock the molecular mechanisms of disease, and to the organisers of randomised placebo-controlled trials to tell us how best to manage patients. If the latter prove inconclusive there are always meta-analyses and systematic reviews. Any truly scientific 21st century medical journal must surely focus on these gold standard studies, and there is little role for the odd and unusual clinical case report. For editors there are other considerations. They want to publish work of the finest quality. Authors prefer to submit their best work to journals with the highest impact factors, and these are derived from a calculation which includes the number of citations made to articles in the journal. In terms of attracting citations, case reports tend to be at the bottom of the pile, and therefore it may not be in the longterm interest of any ambitious biomedical journal to include them in the running order.
E-mail address: [email protected] (Editorial Office). 0163-4453/$34 doi:10.1016/j.jinf.2008.04.007
But perhaps we should not be too quick to dismiss these vignettes. Undoubtedly many case reports are submitted more in the hope of padding out a thin Curriculum Vitae rather than with any intention of expanding scientific knowledge. ‘‘The first case of Bacillus malignus infection in Ruritania’’ (when it is a common pathogen in other nearby countries) is of little interest to the wider world, while it is a surprisingly common belief that just because the author has never seen a particular condition before it must be sufficiently rare as to warrant a paper. The ‘‘case report and review’’ is another common phenomenon: a condition that has been reported frequently enough to not need reporting again, but is too infrequent for any meaningful conclusions to be drawn by briefly summarising the other published cases. On the other hand case reports can serve valuable functions. In the field of infection the first evidence of a genuinely important new organism or infection may be a single case report, and valuable insight into emerging pathogens can appear in this form. Similarly the first evidence of a rare but important adverse drug event may come not from the limited experience of premarketing trials but from a clinical case report once the agent is in wider use. Scientific observations in a single case may not prove anything in themselves, but when presented to a wider audience may trigger larger and more significant studies. Some infections will always be so rare that the only information comes from the anecdotal experience of others: this may not be rigorously evidence-based, but it is much better than no guidance at all. Last but by no means least case reports can entertain and interest, leavening worthy but dry pages of statistical analysis or molecular methods with some real clinical medicine. We believe the readership of the Journal of Infection enjoys reading
94 case reports, and would regret their omission completely from the Journal. Currently JOI receives about 40 case reports each month, of which 95% are rejected. Very few of the latter are bad, and many make reasonably interesting reading, but they do not meet the necessary criteria to warrant publication. Rather than ceasing to publish case reports altogether the Journal would like to provide a showcase for top quality papers, presenting truly original and important work. We therefore propose to continue to publish the best and most original case reports, but will limit this normally to a single paper each month, published in the printed
P. Moss version of the Journal to ensure maximum exposure. It is difficult, given the diverse nature of case reports, to state absolute criteria for acceptance. However, to be considered for publication the paper should fulfil one (or more) of the objectives discussed above. It is helpful if authors explain in their covering letter exactly why they think that their case report is of sufficient interest to be considered. The paper should be well written, and presented ready for publication in an English language journal. Articles should be no longer than 2000 words in length but can include up to three figures or data tables. And please.no more cases of Austrian’s syndrome!