Case Report Publication Checklist

1. Introduction

Case reports play an essential role in advancing medical knowledge by detailing unique clinical observations, previously undescribed syndromes, atypical disease presentations, and novel responses to treatment. As the foundation of many subsequent research studies, case reports serve as an important educational resource that can guide clinical decision making, highlight potential adverse effects of therapies, and identify gaps in healthcare systems.

However, due to the inherent variability in case report quality and the potential ethical ramifications associated with patient privacy, a standardized, comprehensive checklist is critical for ensuring a case or case series merits publication. This article proposes a detailed data collection and evaluation checklist based on established guidelines—such as the CARE Checklist, COPE requirements, and BMJ Case Reports standards—to assist clinicians and researchers in systematically preparing case reports for publication.

Why Case Reports Matter

Case reports serve as valuable cornerstones of medical literature by:

Documenting rare or novel clinical phenomena
Providing educational resources for clinicians
Highlighting unusual therapeutic responses
Identifying potential gaps in healthcare systems
Serving as early signals for emerging health issues

2. Clinical Uniqueness and Educational Value

A cornerstone of a publishable case report is its ability to present valuable, novel, or unusual clinical information that contributes to the wider medical literature. The following points should be assessed when evaluating the educational value and uniqueness of a case:

Previously Undescribed Diseases or Syndromes ▼

Determine if the case involves a condition that has not been previously reported in the literature. Novel entities require detailed documentation and robust evidence to support their presentation.

Uncommon or Atypical Presentations ▼

Evaluate whether the case exhibits an unusual presentation or unexpected manifestation of a well-characterized disease. This may include cases where the clinical signs, diagnostic findings, or progression deviate from established norms.

Unexpected Therapeutic Responses ▼

Identify any beneficial, adverse, or unexpected responses to treatment. Such outcomes, particularly if inconsistent with previous experience, can provide new insights into disease management.

Diagnostic or Therapeutic Challenges ▼

Consider if the case highlights a diagnostic dilemma or a therapeutic challenge due to an unusual combination of symptoms, test results, or events. This may include cases where new diagnostic tools or methodologies were crucial for reaching a correct diagnosis.

Innovation in Treatment or Diagnostic Technology ▼

Assess whether the case involves a novel application of existing therapies or the utilization of new diagnostic technologies (e.g., advanced imaging, genetic or pathologic assessments) that have contributed to resolving the clinical problem.

Insights into Disease Pathogenesis or Healthcare System Gaps ▼

Determine if the case provides new insights into the underlying mechanisms of a disease, or if it reveals inequities and gaps in the healthcare system that have broader implications for patient care.

3. Literature Review and Novelty Confirmation

Before proceeding with a case report submission, it is imperative to establish that the case provides new insights or differs significantly from previously reported cases. This involves:

Conducting a Thorough Literature Search

A systematic literature review must be carried out to confirm that the case has not been previously described or if it offers a distinctly novel perspective compared to past reports. This search helps to substantiate claims of novelty and educational value.

Documenting the Findings

The literature review should include a detailed discussion that highlights similarities and differences with the existing body of work. Where possible, references to prior cases or series should be included to bolster the argument for the case's uniqueness.

Integrating Evidence into the Discussion

By contrasting the current findings with the literature, the discussion section of the case report can clearly articulate the case's contribution to practice, guiding subsequent research and clinical applications.

Literature Search Strategy

An effective literature search should include:

Multiple databases (PubMed, Embase, Scopus)
Appropriate keywords and MeSH terms
Recent publications (last 5 years) and historical context
Both published literature and preprints where relevant
Documentation of search methodology

4. Ethical Considerations and Patient Privacy

Ethical conduct in case reporting is paramount. Addressing ethical considerations ensures the integrity of the publication process and protects patient rights. Key ethical aspects include:

Obtaining Explicit Consent

It is mandatory to obtain explicit, written consent from the patient or their legal representative before publishing any case report details or associated images. Standard treatment consent does not suffice; explicit, case-specific consent is required to fulfill ethical guidelines.

Important: Journal requirements for consent forms may vary. Always check the specific requirements of your target journal.

Handling Cases Involving Vulnerable Patients

In circumstances where the patient's mental capacity is compromised (e.g., patients on ventilation or with impaired decision-making abilities), consent should be secured once the patient regains capacity. If the patient is deceased, untraceable, or if no legal representative is available, appropriate institutional approvals must be obtained in accordance with local regulations and ethical guidelines.

Ensuring Patient Anonymity

Special care must be taken to remove all personal identifiers from the case report, including names, dates of birth, identification numbers, treatment locations, and dates of treatment. Despite these measures, the possibility of indirect identification should be acknowledged in any discussions with the patient or their representative.

Patient Identifiers to Remove:

Names and initials
Dates of birth and exact ages (use age ranges)
Geographical locations smaller than a state/province
Identification numbers (medical record, social security)
Specific dates of procedures or admissions
Rare occupation or unique personal circumstances

Ethics Statement in Manuscripts

A clearly articulated statement on ethics approval and consent must appear in the manuscript. This statement should detail the process of obtaining consent, the measures taken to de-identify patient data, and any institutional approvals where required.

Sample Ethics Statement:

"Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. All patient identifiers have been removed or disguised to protect patient privacy."

5. Structured Data Collection Based on CARE Guidelines

The CARE (CAse REport) Guidelines provide a comprehensive framework for writing case reports. Utilizing this framework guarantees that the report is thorough, systematic, and transparent. The following structured outline guides the data collection process:

5.1 Introduction ▼

Purpose and Significance:

Explain why the case is unique and its potential contribution to the literature. Include a brief review of relevant literature to set the context for the report.

5.2 Patient Information ▼

De-identified Patient Profile:

Collect and document de-identified patient data including age, sex, symptoms, and psychosocial background. Also record the patient's primary concerns, medical history, and any previous interventions, ensuring all identifiers are removed or anonymized.

5.3 Clinical Findings ▼

Physical Examination and Diagnostic Results:

Record all significant clinical findings from examinations, laboratory tests, and imaging studies. Include details such as normal ranges for laboratory values and any notable abnormalities observed.

5.4 Timeline ▼

Chronological Order of Events:

Develop a clear timeline that outlines the patient's presentation, diagnosis, interventions, and follow-up visits. This timeline should be presented either as a figure or in tabular form to enhance clarity.

5.5 Diagnostic Assessment ▼

Diagnostic Methods and Challenges:

List the methods used for diagnostics (e.g., laboratory testing, imaging, physical examinations) and note any diagnostic challenges encountered during the case workup. Include details on differential diagnoses considered and how the final diagnosis was reached.

5.6 Therapeutic Intervention ▼

Intervention Details:

Describe the types of interventions administered including dosages, routes of administration, and any changes in therapeutic strategy over time. This section should also detail any adverse events or unexpected therapeutic responses.

5.7 Follow-up and Outcomes ▼

Outcome Measures and Patient Assessments:

Detail the follow-up clinical assessments, outcomes of the interventions, and any ongoing or resolved issues. Include both patient-reported outcome measures (PROMs) and clinician assessments to provide a comprehensive picture of the case.

5.8 Discussion and Patient Perspective ▼

Interpretation of Findings and Educational Take-away:

Discuss the strengths and limitations of the case, provide an up-to-date review of the literature, and articulate the educational lessons derived from the case. When possible, include the patient's perspective on their treatment experience as this adds significant value and context to the report.

6. Publication Requirements, Authorship, and Competing Interests

For a case report to be publishable, it must conform to the target journal's submission and ethical standards. This includes:

Adherence to Journal Guidelines

Each journal may have specific formatting requirements regarding word limits, the structure of sections (such as the abstract, discussion, and declarations), and the inclusion of supplementary elements (e.g., CARE checklist or visual abstracts). It is important to check and adhere to these guidelines meticulously.

Abstract Preparation

Prepare an abstract that succinctly summarizes the case's background, the unique aspects of the case, the diagnostic and therapeutic interventions employed, and the educational value derived from the case. The abstract should be written in an unstructured or structured format as per the journal's requirements and should not exceed the prescribed word count.

Authorship Criteria

All authors must have contributed significantly to the case report and should agree to be held accountable for the content. The manuscript must include full names, institutional addresses, and conflict-of-interest declarations for all authors. Importantly, the use of non-accountable tools such as Large Language Models for unsupervised authorship is disallowed by many publication guidelines.

ICMJE Authorship Criteria:

According to the International Committee of Medical Journal Editors, authorship should be based on:

Substantial contributions to conception or design; or acquisition, analysis, or interpretation of data
Drafting the work or revising it critically for intellectual content
Final approval of the version to be published
Agreement to be accountable for all aspects of the work

Declaration of Competing Interests

Any financial or non-financial conflicts of interest must be clearly declared within the manuscript to maintain transparency and credibility. This helps readers assess potential biases and ensures adherence to publication ethics.

Ethics and Consent Statements

As reiterated in earlier sections, the paper must include a clear statement regarding the acquisition of ethics approval, patient consent, and the measures taken to protect patient privacy. This declaration is critical for articles involving human participants and must align with both COPE and institutional guidelines.

7. Comprehensive Publication Checklist

The following table consolidates all the key elements clinicians and researchers should verify before deciding to submit a case report for publication. Each checklist item is accompanied by a space for noting whether the requirement has been met and any additional comments.

Checklist Item	Yes/No/NA	Comments
Clinical Uniqueness
1. Previously undescribed disease/syndrome?
2. Uncommon/new presentation of known disease?
3. Unexpected response to treatment?
4. Unusual diagnostic or therapeutic challenge?
5. New use of existing therapy?
6. Use of novel diagnostic technology?
7. New insights into disease pathogenesis?
8. Identifies healthcare system gaps?
Literature Review
9. Comprehensive literature search conducted?
Ethical Considerations
10. Explicit patient consent obtained?
11. Institutional approval obtained when consent is not possible?
12. All patient identifiers removed?
13. Statement acknowledging potential limits in anonymity?
Data Collection (CARE Guidelines)
14. Introduction with case rationale and literature context prepared?
15. Complete de-identified patient information collected?
16. Detailed clinical findings documented?
17. Clear chronological timeline constructed?
18. Diagnostic assessments and challenges described?
19. Thorough description of therapeutic interventions?
20. Follow-up outcomes comprehensively documented?
21. Discussion with literature review and take-away lessons prepared?
22. Patient perspective included?
Publication Requirements
23. Compliance with target journal's guidelines confirmed?
Authorship and Competing Interests
24. All authors agree on content and contributions?
25. All competing interests declared?
Abstract
26. Abstract summarizing case details and significance prepared?

8. Visualizations

Publication Decision Flowchart

Data Collection Elements Based on CARE Guidelines

CARE Section	Data Elements / Focus Areas	Purpose
Introduction	Case rationale, uniqueness, and review of existing literature	To set the context and justify publication
Patient Information	Demographics, medical history, symptoms, prior interventions	To present a de-identified patient profile
Clinical Findings	Physical examination details, test results, imaging findings	To document significant diagnostic information
Timeline	Chronological events, interventions, follow-up visits	To ensure clarity in patient management progression
Diagnostic Assessment	Methods used, diagnostic challenges, differential diagnosis	To detail the process of arriving at the final diagnosis
Therapeutic Intervention	Treatment modalities, dosages, changes in therapy, adverse effects	To document management and patient response
Follow-up and Outcomes	Patient and clinician assessments, additional tests, and outcome measures	To provide a complete picture of the treatment results
Discussion	Literature review, educational value, limitations, and take-away lessons	To analyze and contextualize the case findings
Patient Perspective	Patient's insights and feedback on treatment experience	To incorporate personal experience enhancing report value

Ethical and Consent Process Diagram

9. Conclusion

In summary, a comprehensive checklist is indispensable for clinicians and researchers when deciding whether a case or case series merits publication. This article has provided detailed guidelines and a structured framework that covers the following key areas:

Clinical Uniqueness and Educational Value: Confirm that the case presents a novel or atypical aspect of disease presentation, therapeutic response, or diagnostic challenge.
Literature Review: Ensure that a thorough literature search has been conducted to validate the uniqueness of the case.
Ethical Considerations: Verify that explicit patient consent has been obtained and that all identifying details have been removed, in accordance with ethical and legal standards.
Structured Data Collection: Utilize the CARE Guidelines to systematically document all patient information, clinical findings, diagnostic processes, therapeutic interventions, follow-up outcomes, discussions, and patient perspectives.
Publication Requirements: Adhere to specific journal guidelines, prepare a clear abstract, and ensure transparent declarations regarding authorship and competing interests.

The checklist table and accompanying visualizations provided in this article serve as practical tools to guide clinicians through the intricate process of case report preparation. By ensuring that all these elements are thoroughly addressed, authors can enhance the reliability, transparency, and overall quality of their submissions, ultimately contributing meaningfully to the medical literature.

Key Findings:

A publishable case report must demonstrate clinical uniqueness or provide significant educational value.
Ethical compliance, including explicit consent and safeguarding of patient privacy, is paramount for successful publication.
Adhering to structured data collection frameworks like the CARE Checklist improves the report's clarity and rigor.
Detailed documentation of literature review, diagnostic processes, therapeutic interventions, and follow-up outcomes is required to ensure a comprehensive presentation.
Manuscript preparation must also consider journal-specific guidelines regarding the abstract, authorship, and declaration of competing interests.

This comprehensive checklist not only aids in the decision-making process for potential submissions but also supports the development of high-quality case reports that can stimulate future research and clinical innovation.