GAUTHAM COLLEGE OF PHARMACY

Published patient case reports provide essential sources of information for the optimum care of patients because case reports can describe important scientifi c observations that are missed or are undetectable in clinical trials, provide insightful information that expands our knowledge and spawns new research, and provide information that strays from the classical textbook case and leads to better and safer patient care.

 

 

Format of the patient case report

Case reports should encompass the following five sections: an abstract, an introduction and objective with a literature review, a description of the case report, a discussion that includes a detailed explanation of the literature review, a summary of the case, and a conclusion. Supplementary parts such as tables, figures, graphs, and illustrations provide essential data and will enhance the article’s flow and clarity. Generally, most of the data contained in supplementary parts should not be duplicated in the text. Patient case reports can describe a single case report or a series of case reports. Case reports are generally 1500–2500 words in length with 20–30 references The title of the case report should be descriptive, accurate, and succinct.

 

Abstract. Case reports should include an abstract of 100–250 words. The availability of an abstract will allow for easier retrieval from electronic databases and help researchers discern their levels of interest in the case report. The abstract should include the same four sections as the main text in a succinct form—introduction and objective, case presentation, discussion, and conclusion—but the format may vary depending on a journal’s style if submitted for publication. 

 

Introduction. The introduction section should be concise and salient and immediately attract the attention and interest of the reader. The introduction should provide the subject, purpose, and merit of the case report. It should present background information that provides clarity to the subject of discussion. This should be followed by an explanation of why the case report is novel or merits review. A focused comprehensive literature review that corroborates the author’s claims should accompany the introduction. If few citations are found, they should all be cited chronologically; however, if many citations are found, the seminal, historical, and most pertinent references should be cited. The significant details from the literature review and how those details compare and contrast to the current case should be explained in the discussion, not in the introduction. A brief one- or two-sentence description of the patient case should be provided and is an excellent segue for the case presentation section. The introduction should not be more than three paragraphs and does not need to be labeled with a heading (i.e., Introduction). A literature review should list the strategy and extent of the search and should include the database searched, the dates that the database was searched, the languages covered, and the search terms used. The literature search should provide enough detail for the reader to easily reproduce the search. Databases that are commonly searched because of their comprehensiveness of biomedical content include MEDLINE and EMBASE. However, it is important that the breadth of the search uses databases that contain information that may not be found in MEDLINE or EMBASE. For example, a case report of an adverse drug event or medication error should include a review of an adverse reaction database such as Clin-Alert or databases that review pharmacy publications such as International Pharmaceutical Abstracts and Iowa Drug Information Service. A case report describing the collaboration of a pharmacist and a nurse that improves a patient’s care should include a search in the nursing database such as the Cumulative Index to Nursing and Allied Health Literature. Furthermore, to maximize the literature search findings, authors should meticulously search the reference lists of review articles and metaanalyses. Finally, clinicians ought to be cognizant that early reports may not be detected in a literature search because of changes in concepts, nomenclature, and terminology since their publication date.

 

Case presentation. The description of the patient case is one of the most integral sections of the case report. It should describe the case in chronological order and in enough detail for the reader to establish his or her own conclusions about the case’s validity. A case report that contains detailed and relevant patient information allows the reader with a different clinical expertise to uncover idiosyncracies that are not detected or described by the author and stimulates further inquiry and commentary. The case presentation should only include information that pertains to the case and refrain from providing confusing and superfluous data. Daily patient progress including normal vital signs, routine laboratory results, typical consultation with other disciplines, step-down transfers to wards, and other irrelevant patient information must be avoided. The author should establish a causal and temporal relationship and indicate the effect of treatment, any unanticipated effects, the patient’s final outcome, any further proposed treatments, and the patient’s present status at the time of the report. 

Patient’s demographics and history. Patient demographics such as age, height, weight, sex, race, and occupation must be included. Although the race or occupation of the patient may appear as superfluous, this type of information may uncover pharmacogenomic or environmental influences. In order to limit the possibility of identifying the patient, the patient’s initials, date of birth, and other identifiers must not be used. Precise dates, including the month, day, and year of admission or other important events, should be avoided—they can aid in identifying the patient and detract the reader from the case report by calculating elapsed time. In a brief summary and in a narrative form, the patient’s chief complaint, present illness, medical history, family and social history, and use of recreational drugs should be listed. Headings for each part of the patient’s history should not be used. The type of physical examination performed should be described, and any abnormalities should be reported. Patient’s laboratory and diagnostic data. The patient’s laboratory values and diagnostic data that support the case report and rule out a differential diagnosis should be reported. Pertinent positive or negative laboratory results must be provided. When the reference range of a laboratory value is not widely known or established, it should be provided in parentheses. Diagnostic procedures, the timeline in which they were administered, and a brief report of the results should be included of a pathologist’s report must not be used; instead, a salient report of the results should be included. Pictures of histopathology, roentgenograms, electrocardiographs, and other diagnostic tests; skin manifestations; wounds; and other anatomical parts may be provided and add to the interest of the report. Any identifying features of a patient’s photograph should be blocked out. Institutional policies and patient permission for obtaining and using photographs must be followed. 

 

Patient’s medication history. The patient’s medication history should include the medication’s name, strength, dosage form, route, and dates of administration. The brand or generic name of the drug and the name of the manufacturer may be relevant to the case and should be listed. Brand and generic drugs may have different bioavailability factors or may contain different fi llers, preservatives, additives, or dyes—all of which may be pertinent to cases regarding the drugs’ pharmacokinetics, effi cacy, and adverse effects. Since a medication history may often omit herbals, vaccines, depot injections, and nonprescription medications, the author should specify the history of each of these medication types. The dates a medication was discontinued should be identified, since medications may have lasting effects for months after discontinuation. The author should verify and inform the reader of the patient’s history of medication adherence. 

 

Patient’s diet. The patient’s diet history ought to be included in the case report. Food can interact with medications, yielding lower or higher serum drug levels or increasing or decreasing the drug’s pharmacologic effect. The patient’s diet can have consequential effects on a disease state. Dietary causes of adverse events, such as allergic reactions, should be ruled out before suspecting a drug allergy 

 

Discussion. The discussion section is the most important section of the case report. The discussion should evaluate the patient case for accuracy, validity, and uniqueness; compare and contrast the case report with the published literature; and derive new knowledge and applicability to practice. The author must confi rm that the case report is valid by ensuring the accuracy of the data presented and by establishing a temporal and causal relationship. For drug-induced adverse effects, a validated nomogram to establish the probability of causality such as the Naranjo nomogram must be used.8 The author should comprehensively list the limitations of the case and should describe the signifi cance of each limitation The author should briefly summarize the published literature derived from the literature review and may provide a detailed summary of a few citations. A table listing the pertinent facts of the cases detected from the literature review is a simple method for providing extensive, detailed data in an interpretable form. The author should compare and contrast the nuances of the case report with the published literature and should explain and justify the differences and similarities.

The discussion section of a case report is in no way designed to provide comprehensive details of each citation of an all-inclusive and extensive literature review—this should be saved for review articles. All the references cited should be critically evaluated. Transferring an unread reference cited in another article is unethical and will place the author of the case report at risk of error and embarrassment.

The author should next summarize the essential features of the case report, justify why this case is unique, and draw recommendations and conclusions.

Conclusion. Based on the evidence reviewed in the discussion section, the author must provide a justified conclusion. The author must be careful not to make firm judgments and sweeping recommendations based on speculation, on limited and tenuous information, or on a few case reports. However, justifiable evidence-based recommendations should be stated. The author may suggest that clinicians be cognizant of the insight learned from the case or suggest heightened vigilance, prudent management, avoidance, further study before taking action, or new ideas for investigation. How the information discovered from the case report will apply to the author’s practice should be described. This section should be concise and not exceed one paragraph. Guidelines for writing patient case reports in a checklist format (Appendix B) can facilitate and enhance the manuscript writing process.

Summary Patient case reports are valuable resources of new and unusual information that may lead to vital research and advances in clinical practice that improve patient outcomes.

 

Case reports should contain an abstract and four sections—an introduction, case presentation, discussion, and conclusion. The introduction provides the subject, purpose, and merit of the case report and the strategy used for the literature review. The patient case presentation should be descriptive, organized chronologically, accurate, salient, and presented in a narrative form.

*The discussion should compare and contrast the case report’s findings with the literature review, establish a causal and temporal relationship, and validate the case with a probability scale.

*The literature review should be extensive and should support the justification of the case report.

*The discussion section should end with a brief summary of the case with rational recommendations and conclusions.

*The conclusion section must provide a brief conclusion with evidence-based recommendations