1. 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)

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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