How to Write a Case Report 101 “Interesting case! Should we report it?” How to Write a Case Report 101 Dr. Emmanuel Abara FRCS(C) FACS FICS Richmond Hill Urology Practice & Prostate Institute (RHUPPI) Northern Ontario School of Medicine (NOSM)

Conflict Disclosure Information: Presenter: Emmanuel O. Abara MB FRCSC.FACS.FICS Title of Presentation: “Interesting Case! Should we report it?”: How to Write a Case Report 101 I have no financial or personal relationships to disclose

Learning Objectives Determine what types of cases are worth reporting and why Understand how to structure a Case Report Learn what audience to reach and what journals to publish in Understand the Ethics of Publishing

Target Audience Physicians in active clinical practice Faculty seeking to review their knowledge on Case Report publishing Fellows Residents Research Assistants Learners

Background Case report is like story telling in medicine Should be clear, short and useful for its purpose Is the written form of the verbal presentation of a case history Case reports are the lowest cadre in the world of evidence-based medicine Can be powerful and instructional

Why a Case Report? We need to understand the reasons for the intent to publish To assist in structure of the article To help target the journal and audience To include in an introductory Letter to the Editor

Possible Reasons For a Case Report Very rare disease Association of diseases Rare presentations of more common diseases Outcome of a novel treatment Reporting a particular outcome of a case management Mistakes, complications and lessons learned A new disease entity

Choice of Journal Select a number of journals Review the various formats of the journals Make a decision which format may fit your Case Report best, e.g.: “Lesson of the Year” or “Photo Quiz” Review published case reports in the journal of choice Follow the guidelines and instructions precisely, especially regarding word count, figures and tables

Structure Your Case Report Abstract Introduction The Case Report Discussion Conclusion; Lessons Learned References Acknowledgement

Review of Contents Abstract: Brief summary (not required by all journals) Introduction: Background information and why the case is being reported

Review of Contents Case Report History Physical Examination Presenting features Past Medical History Social and Family History Drug History Physical Examination Investigations Differential Diagnosis Treatment Outcome

Essentials Anonymise the patient(s) as much as possible Avoid names and initials Omit non-essential personal details Table of results can be helpful Photos of clinical signs and diagnostic studies are invaluable

Discussion Clarify key issues Refer to other cases in the literature A short review of the literature is appropriate Include the methodology used for literature search Message or lesson(s) learned

Get Help, Second Opinion, or Third Opinion Get advice early! Especially regarding: Key Message and Reason for the Case Report Get others not involved in the management of the case to proofread the article and consider their comments carefully

Ethics of Publishing a Case Report Consent Consider privacy laws Duty of confidentiality persists even if the patient has died, e.g.: Role of Next-of-Kin Deliver a copy of published paper to the patient or relative

Ethics of Publishing a Case Report: Criteria for Publication Without Patient’s Consent Publication should be in the public interest Every effort to contact patient or next-of-kin should have failed Every effort to anonymise the case report should be made Average person unlikely to withhold consent

Ethics of Publishing a Case Report: Authorship Consider assent to publish from other clinicians involved in the care of the patient Authors included need to have intellectual input Avoid a “soccer team” of authors Many journals may limit the number of authors Letters and consent from various named co-authors may be required

Article Submission Have all the consents and assents to publish Follow all the instructions and guidelines of the journal webpage Write and include a cover letter to the editor

“Publish or Perish” or “Publish and Prosper” A Case Report may be the beginning of a glorious and successful career in medical writing!