Editorial Open Access
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2024; 12(24): 5452-5455
Published online Aug 26, 2024. doi: 10.12998/wjcc.v12.i24.5452
Are case reports valuable? Exploring their role in evidence based medicine and patient care
Tarun Kumar Suvvari, Department of Clinical Research, Squad Medicine and Research (SMR), Amadalavalasa 532185, Andhra Pradesh, India
Tarun Kumar Suvvari, Department of Medicine, Rangaraya Medical College, Kakinada 533001, Andhra Pradesh, India
ORCID number: Tarun Kumar Suvvari (0000-0003-0063-0339).
Author contributions: Suvvari TK contributed idea, conceptualization, supervision, writing and revision of draft, and approved final draft.
Conflict-of-interest statement: Author declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tarun Kumar Suvvari, MBBS, Academic Research, Doctor, Department of Clinical Research, Squad Medicine and Research (SMR), First Floor, SMR Main Office, 17-2-49/2, Vengalarao colony, Amadalavalasa 532185, Andhra Pradesh, India. drtarunsuvvariresearch@gmail.com
Received: March 8, 2024
Revised: May 15, 2024
Accepted: May 24, 2024
Published online: August 26, 2024
Processing time: 124 Days and 17.4 Hours

Abstract

Case reports, often overlooked in evidence-based medicine (EBM), play a pivotal role in healthcare research. They provide unique insights into rare conditions, novel treatments, and adverse effects, serving as valuable educational tools and generating new hypothesis. Despite their limitations in generalizability, case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals. By acknowledging their limitations and adhering to reporting guidelines, case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM. This editorial explores the intrinsic value of case reports in EBM and patient care.

Key Words: Clinical cases, Case reports, Evidence based medicine, Editorial, Healthcare research

Core Tip: Case reports are indispensable in evidence-based medicine, offering crucial insights into rare cases and innovative treatments. While they are not as robust as randomized controlled trials or observational studies, case reports provide essential information that can guide clinical decision-making and stimulate further research. Embracing the significance of case reports can enrich medical education and improve patient outcomes.



INTRODUCTION

Case reports have historically played a vital role in medical research, with examples like Louis Pasteur's work on the rabies vaccine and Sigmund Freud's studies on hysteria[1]. In present scenario, case reports also play a crucial role in evidence-based medicine (EBM) and patient care by providing valuable insights into novel aspects of diseases, therapies, and adverse effects of treatments[2]. Despite being placed low on the evidence hierarchy, case reports are essential for signifying novel occurrences, generating hypotheses, and serving as the first-line evidence to test statistical methods[2]. They permit the discovery of new diseases, unexpected clinical scenarios and pathophysiology, contributing to medical education and the study of rare conditions that may not be feasible to study in large-scale trials[3]. Additionally, case reports can provide a narrative that complements quantitative data, offering a more holistic view of patient care and outcomes[4].

Case reports have traditionally been a cornerstone of medical literature, providing valuable insights into rare conditions, unusual presentations, and treatment outcomes. However, with the rise of EBM, there has been a debate on the relevance and role of case reports in modern medical practice. Proponents of EBM argue that case reports, due to their anecdotal nature and limited generalizability, are of lower quality evidence compared to systematic reviews and randomized controlled trials[5]. The emphasis on rigorous research methodologies and systematic reviews in EBM has led some to view case reports as outdated and potentially misleading[6].

Despite these criticisms, some scholars argue that case reports still hold value in the era of EBM. They suggest that while EBM emphasizes quantitative analysis and systematic reviews, there are aspects of clinical practice that resist such quantification, such as tacit knowledge and humanistic considerations[7].

Furthermore, case reports continue to be published in reputable medical journals, indicating ongoing interest and relevance in the medical community[3,4]. They offer a platform for sharing unique clinical experiences, innovative treatments, and unexpected complications that can contribute to medical knowledge and patient care[4]. While EBM remains a critical foundation for clinical decision-making, the integration of case reports alongside systematic reviews and clinical trials can enrich the evidence base and provide a more comprehensive understanding of complex medical scenarios[8].

IMPORTANCE OF CASE REPORTS

As a physician point of view, importance of case reports include:

Evidence generation

Well-written case reports contribute to evidence generation and clinical practice by offering valuable information to clinicians when other evidence is lacking[9].

Investigating new hypotheses

Case reports can stimulate further investigations, leading to the discovery of new diseases, therapeutic approaches, or indications for existing treatments[8,9].

Early detection of emerging diseases

In the early stages of a new or emerging disease, case reports are often the first source of information. They can help healthcare professionals recognize patterns, symptoms, and potential treatment strategies before large-scale studies are conducted[9,10]. For example, Kaposi’s Sarcoma was published as a case series, stating that all the cases had in common homosexual practices, suggesting possible sexual transmission of an unknown infection which turned out to be as the first report of human immunodeficiency virus-acquired immunodeficiency syndrome[1,11]. Similarly, single cases of Influenza Virus, Ebola Virus, and SARS-CoV virus were initially reported, which eventually escalated into global outbreaks[1,12].

Rare or unusual cases

Case reports are particularly valuable when dealing with rare or unusual medical conditions. Since RCTs often focus on common diseases, case reports can shed light on atypical presentations, unusual complications, or rare side effects of treatments[4,6]. For instance, several genetic conditions like neurofibromatosis type 1, trisomy 18, and Wolf-Hirschhorn syndrome, were first identified and published as single case report[1,13].

Educational value

Case reports are beneficial tools in graduate medical education, helping students acquire clinical competencies and apply evidence-based thinking in practice-based learning[10,14].

LIMITATIONS OF CASE REPORTS
Small sample size

Due to their nature, case reports have a small sample size, limiting their ability to infer causality or calculate incidence or prevalence[4,15].

Generalizability concerns

Case reports lack generalizability and may not be representative of broader patient populations or clinical practices[4,16].

Retrospective design

Retrospective design may lead to missing relevant data not documented in medical records, affecting the completeness of the report[4].

EDUCATIONAL VALUE AND FUTURE PERSPECTIVES
Skill development

Writing case reports can enhance critical thinking, observational skills, medical writing abilities, and hypothesis generation for young doctors and medical students[14,17].

Patient-centered care

Case reports contribute to patient-centered care by highlighting unique cases, rare manifestations of diseases, and adverse effects of treatments[14,17].

Professional development

Engaging in case reporting can provide valuable experience with the editorial process, motivate scholarly views on clinical work, and improve understanding of patient-centered care[14,17].

DISCUSSION

Case reports serve as a platform for training medical students, residents, and fellows in scientific writing and critical thinking[17]. They enhance awareness of rare disorders, clarify new aspects of disease etiology, and describe treatment responses, contributing to better-informed healthcare professionals. By documenting new or innovative treatments, case reports can stimulate further investigations and the discovery of novel therapeutic approaches[14]. They provide a starting point for exploring potential interventions and outcomes. Case reports offer a structured approach to case-based learning in healthcare education. They facilitate the comparison of clinical scenarios, aiding in the evaluation, diagnosis, treatment, and prognosis of diseases[14,17].

While case reports may not provide generalizable results like larger studies, they offer detailed qualitative and quantitative clinical information on individual patients that can complement evidence from group studies[18]. This supplemental data can contribute to a more comprehensive understanding of disease management. Case reports help in sharing information about rare disorders that may not be investigated through controlled clinical trials due to their low incidence. They also play a crucial role in drug safety surveillance by documenting adverse effects promptly[18,19].

A dedicated issue to case reports would serve as a platform to share valuable clinical experiences[9]. This would not only facilitate the identification of rare pathologies and novel diseases but also shed light on atypical presentations of common ailments. Even seemingly unique or outlier cases can hold significant value for researchers and clinicians, potentially uncovering previously unrecognized drug interactions or subtle disease manifestations.

CONCLUSION

In conclusion, case reports still hold a valuable role in EBM, as they continue to offer valuable insights into rare conditions, treatment outcomes, and unexpected effects. Case reports play a crucial role in medical education, hypothesis generation, and contributing to the understanding of complex medical scenarios. While systematic reviews and randomized controlled trials are prioritized in evidence hierarchy, case reports provide a narrative perspective that complements quantitative data, enriching the evidence base and enhancing patient care. Acknowledging the unique value of case reports alongside other forms of evidence can lead to a more comprehensive understanding of patient care and outcomes.

Footnotes

Provenance and peer review: Invited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Medicine, research and experimental

Country of origin: India

Peer-review report’s classification

Scientific Quality: Grade B

Novelty: Grade C

Creativity or Innovation: Grade C

Scientific Significance: Grade B

P-Reviewer: luo W, China S-Editor: Gao CC L-Editor: A P-Editor: Zhao YQ

References
1.  Nissen T, Wynn R. The history of the case report: a selective review. JRSM Open. 2014;5:2054270414523410.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 47]  [Article Influence: 4.7]  [Reference Citation Analysis (0)]
2.  Carey JC. The importance of case reports in advancing scientific knowledge of rare diseases. Adv Exp Med Biol. 2010;686:77-86.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 42]  [Cited by in F6Publishing: 46]  [Article Influence: 3.3]  [Reference Citation Analysis (0)]
3.  Vandenbroucke JP. In defense of case reports and case series. Ann Intern Med. 2001;134:330-334.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 325]  [Cited by in F6Publishing: 314]  [Article Influence: 13.7]  [Reference Citation Analysis (0)]
4.  Nissen T, Wynn R. The clinical case report: a review of its merits and limitations. BMC Res Notes. 2014;7:264.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 216]  [Cited by in F6Publishing: 298]  [Article Influence: 29.8]  [Reference Citation Analysis (0)]
5.  Browman GP. Essence of evidence-based medicine: A case report. J Clin Oncol. 1999;17:1969-1973.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 18]  [Article Influence: 0.7]  [Reference Citation Analysis (0)]
6.  Neely JG, Karni RJ, Nussenbaum B, Paniello RC, Fraley PL, Wang EW, Rich JT. Practical guide to understanding the value of case reports. Otolaryngol Head Neck Surg. 2008;138:261-264.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 20]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
7.  Henry SG, Zaner RM, Dittus RS. Viewpoint: Moving beyond evidence-based medicine. Acad Med. 2007;82:292-297.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 16]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
8.  Henry SG, Dittus RS, Zaner RM. The role of evidence-based medicine. Acad Med. 2008;83:996; author reply 996.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
9.  Mishra S. Are medical breakthroughs declining - The importance of case reports? Indian Heart J. 2015;67 Suppl 3:S1-S3.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
10.  Novoa NM. Editorial: Case-reports, a compendium of useful ideas for our daily activity. Front Surg. 2022;9:1026401.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
11.  Pokrovskiĭ VV, Iurin OG, Kravchenko AV, Potekaev NS, Gabrilovich DI, Makarova NIu, Potekaev SN. [The first case of HIV infection in a citizen of the USSR]. Zh Mikrobiol Epidemiol Immunobiol. 1992;19-22.  [PubMed]  [DOI]  [Cited in This Article: ]
12.  Wiwanitkit V. The usefulness of case reports in managing emerging infectious disease. J Med Case Rep. 2011;5:194.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
13.  Nakamura T, Igarashi H, Ito T, Jensen RT. Important of case-reports/series, in rare diseases: Using neuroendocrine tumors as an example. World J Clin Cases. 2014;2:608-613.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in CrossRef: 23]  [Cited by in F6Publishing: 22]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
14.  Cabán-Martinez AJ, Beltrán WF. Advancing medicine one research note at a time: the educational value in clinical case reports. BMC Res Notes. 2012;5:293.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 26]  [Cited by in F6Publishing: 29]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
15.  Bayram A. CARE (CAse REport) Guidelines: A Recipe for More Transparent Case Reports. Turk Arch Otorhinolaryngol. 2022;60:63-64.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
16.  Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, Werthmann PG, Moher D, Rison RA, Shamseer L, Koch CA, Sun GH, Hanaway P, Sudak NL, Kaszkin-Bettag M, Carpenter JE, Gagnier JJ. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218-235.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 741]  [Cited by in F6Publishing: 775]  [Article Influence: 110.7]  [Reference Citation Analysis (0)]
17.  Lowenfels AB, Mamtani R, Solomon LW, Maisonneuve P, Cheema S. The Value of Case Reports for Graduate Medical Education. J Grad Med Educ. 2022;14:529-532.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
18.  Sayre JW, Toklu HZ, Ye F, Mazza J, Yale S. Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education. Cureus. 2017;9:e1546.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 18]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
19.  Parums DV. Editorial: The Increasing Relevance of Case Reports in Medical Education and Clinical Practice - and How to Write Them. Am J Case Rep. 2023;24:e942670.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]