- Case report considered as a base of the evidence pyramid. - Case report had a crucial role in explaining abnormal data and elaborating some research theories or questions. - Writing a case report needs to be stick for the CARE CHECKLIST. - Abstract is written in the beginning of the case report, but it will be the last part to be written. - Don’t forget deidentified patient data. - Don’t forget Informed Consent.

1. Tips for A case Report
Writing
Presented by :
Mostafa Meshref
Assistant lecturer of Neurology,
Faculty of Medicine, Al-Azhar
University, Cairo, Egypt.
1

2. AGENDA
- What is a case report?
-What are the reasons for publishing a case
report?
-Importance and magnitude of case report
writing.
- Selection of a case report (Which case report is
suitable for publication?).
- Tips that may help.
- Writing Sequence.
- CARE Checklist.
- Take a home message.
- References.
2

3. WHAT IS A CASE
REPORT?
- A Case Report is a detailed report
of the symptoms, signs, diagnosis,
treatment, and follow-up of a
patient.
- Case Reports may contain a
demographic profile of the patient,
but usually describes an unusual or
novel occurrence.
- Case reports usually describe an
unusual or novel occurrence and as
such, remain one of the
cornerstones of medical progress
and provide many new ideas in
medicine.
3

4. EVIDENCE PYRAMID (EVIDENCE BASED- MEDICINE)
 Medical scientists and
practitioners rank evidence
according to its quality.
 When these types of
evidence are ranked as
levels, one on top of the
other, the resulting image
takes the form of a pyramid,
because the higher the
quality of evidence, the rarer
it is, and the lower the
quality of evidence, the more
ubiquitous it is.
 Editorial, expert opinions
and case reports are at the
base of the pyramid.
 The highest quality evidence
(level 1 evidence) is the
systematic review:
Evidence pyramid Evidence pyramid and type of
the study design
4

5. WHAT ARE THE REASONS FOR PUBLISHING A CASE REPORT?
(1) An unexpected association between diseases or symptoms.
(2) An unexpected event in the course observing or treating a patient.
(3) Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.
(4) Unique or rare features of a disease.
(5) Unique diagnostic or therapeutic approaches or variation of anatomical structures.
(6) To contribute to medical education: Case reports can be a valuable teaching tool for medical students
and residents. They can provide real-world examples of how diseases present, are diagnosed, and are
treated.
5

6. IMPORTANCE AND MAGNITUDE OF CASE REPORT WRITING.
1 - Case reports are an undervalued component of the medical literature.
2 - Case reports play a crucial role in medicine and scientific research.
3-Case reports form the foundation of the evidence-based pyramid; these early observations
inform larger, more rigorous research studies which can have far-reaching implications for
population and public health.
4-Case reports allow clinicians to share experiences that may deviate from the accepted
standards of care, either because a case does not fall within the scope of established
guidelines or due to patient preference regarding treatment.
5- Education for future practitioners: Case reports act as valuable teaching tools for medical
students and residents. By showing real-world scenarios of disease presentation, diagnosis,
and treatment, they provide crucial context to theoretical knowledge.
6

7. CASE REPORTS HAVE AN IMPORTANT ROLE IN:
(1) Identifying Rare or Unusual Cases.
(2) Generating New Hypotheses.
(3) Providing Early Warning Signal.
(4) Improving Medical Education.
(5) Shaping Healthcare Policy and patient safety.
(6) Documentation of Medical History.
7

8. MAGNITUDE OF CASE REPORT
A single case report can significantly influence medical practice, particularly when it reveals some novelty
and significance of the information presented.
1-Global Impact: hinges entirely new or challenges conventional wisdom.
2- Cumulative Knowledge: the accumulation of numerous case reports over time contributes to a
comprehensive understanding of various medical conditions and treatments. Over time, a collection of
case reports on a particular topic can paint a clearer picture of a disease or treatment, influencing future
clinical practice guidelines.
3- Foundation for Large-Scale Studies: They provide a foundation upon which further research and
clinical decisions can be based. (Spark new research questions, hypotheses and Prompt the development of
larger-scale studies like clinical trials.
4- Public Awareness: Case reports can be used to raise awareness about specific health issues. By sharing
real-life stories, they can educate the public about risk factors, symptoms, and treatment
options, empowering individuals to make informed decisions about their health.
5- Ethical Considerations: Case reports can contribute to ethical discussions and debates within the
medical field. By exposing ethical dilemmas and raising questions about patient privacy, informed
consent, and responsible research practices, they can lead to improvements in ethical standards.
8

9. SELECTION OF A
CASE REPORT
(Which case report is suitable
for publication? )
9

10. *Most journals publish case reports that deal with one or more of the following:
• Unusual observations.
• Adverse response to therapies.
• Unusual combination of conditions leading to confusion of the diagnosis.
• Illustration of a new theory.
• Question regarding a current theory.
10

11. SO, WHAT I WILL DO (OR) WHAT I SHOULD OBSERVE?
*Identifying the Category of My Case Report,
Is my case report having one of the following or not ?
• An unexpected association between diseases or symptoms.
• An unexpected event in the course of observing or treating a patient.
• Findings that shed new light on the possible 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.
11

12. FIRST TIPS THAT MAY HELP:
 First: Select a case and identify the message you wish to communicate, as well as
your audience. Is this case report about an outcome, a diagnostic assessment, an
intervention, a new or rare disease, or something else?
 Second: Gather the necessary information to accurately write WHAT happened as a
timeline and as a narrative. Create the timeline of your case report—a visual summary
of WHAT happened in the case report (see examples of timelines that follow the
CARE guidelines) before writing the narrative section.
 Third: Complete the remainder of the case report using specialty-specific
information, if necessary, with appropriate scientific references and explanations.
Support WHY an outcome occurred with reference to the scientific and historic
literature whenever possible. Write the abstract last.
 Fourth: De-Identification: Patient information must be de-identified and informed
consent obtained prior to submitting your case report to a journal.
12

13. WRITING SEQUENCE
**There is a standard steps for writing
the case report called (The 2013 CARE
Checklist ): (will be discussed at the end
of the lecture).
Start by:
1- Title – The diagnosis or intervention
of primary focus followed by the words
“case report”.
- The title is followed by the authors and
their affiliations.
13

14. 2- Key Words – 2 to 5 key words that identify diagnoses or
interventions in this case report (including "case report").
3- Abstract – (structured or unstructured)
The last part to be written at the case report. However, it is located
at the beginning of the case report manuscript.
‫الحالة‬ ‫ملخص‬
(
‫الحالة‬ ‫مقدمة‬ ‫في‬ ‫تكتب‬ ‫ولكنها‬ ،‫الكتابة‬ ‫في‬ ‫خطوة‬ ‫آخر‬
)
The abstract should summarize the case, the problem it addresses,
and the message it conveys. Abstracts of case studies are usually
very short, preferably not more than 150 words.
It includes:
a) Introduction (or Background) – What is unique about this
case and what does it add to the scientific literature?
b) The patient’s main concerns and important clinical
findings.
c) The primary diagnoses, interventions, and outcomes.
d) Conclusion – What are one or more “take-away” lessons
from this case report?
14

15. 4- Introduction – Briefly summarizes why this case
is unique and may include medical literature
references.
The introduction gives a brief overview of the
problem that the case addresses.
- Citing relevant literature where necessary.
-The introduction generally ends with a single
sentence describing the patient and the basic
condition that he or she is suffering from.
**The introduction as general roles:
1-What we know?
2-What don’t we know?
3- What our case or our research will add to the
literature?
15
What we Know?
What don’t we know?
What will we add?

16. 5- THE CASE PRESENTATION:
• This section provides the details of the case in the following order:
-A brief history and important and relevant positive and negative findings with details of investigations. This includes:
- Patient description. - Case history.
- Physical examination results.
- Results of pathological tests and other investigations.
- Treatment plan (doses, regimens, scientific names, labelled or approved drugs, and don’t use off-labelled drug).
- Expected outcome of the treatment plan.
- Patient prognosis.
- Actual outcome (follow-up visits). 16

17. * Don’t forget deidentified patient data.
**Don’t forget Informed Consent and Patient Perspective.
- The patient should provide informed consent and the author should provide this information if
requested.
- Some journals have consent forms which must be used regardless of informed consents you have
obtained. Rarely, additional approval (e.g., IRB or ethics commission) may be needed.
17

18. EXAMPLE
18
Case presentation, Clinical findings and
examination
Follow up brain imaging and labs
Detailed history
examination
lab, imaging,
medication
follow-up
prognosis.

19. CASE PROGRESSION AND FINAL OUTCOMES
19

20. 6- DISCUSSION
 This is the most important part of the case report.
 The part that will convince the journal that the case is publication worthy.
 This section should start by expanding on what has been said in the introduction,
focusing on why the case is noteworthy and the problem that it addresses.
 Explain the objective of reporting the case.
 Describe what others have written before about the condition or any related feature.
 Describes the existing theories and research findings on the key issue in the patient's
condition. This will help in decreasing the confusion or the main challenge in the
case.
 Mention studies which support your case presentation (if present) and the possible
interpretations.
 Note: Some journals may ask for a summary of the existing literature on the topic. (If
the journal specifies a separate section on literature review, it should be added before
the Discussion). 20

21. EXAMPLE OF THE DISCUSSION
21
-Expanding knowledge about the case
- why the case is unique?
- Explain important case findings
- Mention similar cases
- Explanation of the findings of your
case.

22. 7- CONCLUSION
 A case report ends with a conclusion or with
summary points.
 This section should briefly give readers the
key points covered in the case report.
 Here, the author can give suggestions and
recommendations to clinicians, teachers, or
researchers.
 Depending on the journal's specified format.
)some journals don’t require this section in
writing a case report, so better to refer to
author guidelines when you submit to a
journal).
22
Example:

23. CARE CHECKLIST
23

24. 24

25. TAKE A HOME MESSAGE
 Case report considered as a base of the evidence pyramid.
 Case report had a crucial role in explaining abnormal data and elaborating some research theories or
questions.
 Writing a case report needs to be stick for the CARE CHECKLIST.
 Abstract is written in the beginning of the case report, but it will be the last part to be written.
 Don’t forget deidentified patient data.
 Don’t forget Informed Consent.
25

26. REFERENCES FOR FURTHER READING
case reports: explanation and elaboration document
 CARE guidelines for case reports: explanation and elaboration document; link:
https://www.jclinepi.com/article/S0895-4356(17)30037-9/fulltext
 2013 CARE Checklist link: https://www.care-statement.org/checklist
 Writing a Case Report; link: https://www.care-statement.org/writing-a-case-report
 Guidelines To Writing A Clinical Case Report; link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686928/#:~:text=A%20case%20report%20is%20a,up%20of%20
an%20individual%20patient.
 Ten Steps to Writing an Effective Case Report (Part 1); link: https://www.enago.com/academy/ten-steps-to-
writing-an-effective-case-report-part-1/
 Ten Steps to Writing an Effective Case Report (Part 2); link: https://www.enago.com/academy/ten-steps-to-
writing-an-effective-case-report-part-2/
- ARE guidelines for case reports: explanation and elaboration document
26

27. 27
For more information and feedback please, contact me at:
MostafaMahmoud.236@azhar.edu.eg
mostafameshref1988@gmail.com