Writing a case report

Yoshida, Winston Bonetti

doi:10.1590/S1677-54492007000200004

EDITORIAL

Editor-in-chief, J Vasc Bras.

The case report is one of the most common types of presentation in congresses or publication in journals. Although it is not considered a high evidence level scientific source (level VII),¹ it is an important source of information that usually remains forgotten or excluded from large multi-centered studies,² and that can provide essential subsidies for a better treatment of patients in certain situations. For example, the first publication about the association of Kaposi's sarcoma with AIDS was performed through a case report.³ The same occurred with the first report of stent-graft implantation for the treatment of abdominal aortic aneurysm.^4.5

According to the guidelines of most journals, including ours, case reports are pertinent when: diagnosed entity is rare; treatment is pioneering or presents some innovation; or result is unusual. From the ethical perspective, based on some Ethics Committees, there is apparently no need of previous approval for case reports, but it is recommended to obtain the patient's consent whenever possible. Conflicts of interest should be declared.

To make a case report play this important informative role, adequate content and sequence are required. The basic structure of a case report includes title, abstract, introduction with objective, description of a case, technique or situation, discussion with literature review, conclusion and references. Additionally, figures, tables, graphs and illustrations complement this type of publication. The manuscript should have between 1,500 and 2,500 words and 20 or 30 references at the most. As all publications, the text should be simple, clear, accurate and concise.⁶

The title should be brief, descriptive and accurate.² The abstract should have between 150 and 200 words, comprehending all the items described in the text. Depending on the journal, it should be structured or not. The introduction should be equally concise and bring available information about the topic being discussed, context, merit and objective of the report, so that it attracts the reader's attention. It is recommended to perform an extensive literature review about the theme, but it is not mandatory to include all that has been surveyed, only what is more relevant and comprehensive.⁷ If the number of quotations found is small, they can be placed on chronological order or, if there is a large number of them, they can be grouped by a certain criterion.⁶ The search strategy used to find references and databases used should be informed. This search usually includes at least MEDLINE, EMBASE, LILACS and SciELO databases. References concerning review articles, systematic reviews and meta-analyses should be equally explored for a comprehensive review.

In the case description, the sequence should be chronological, organized, with sufficient details to allow readers to have their own interpretation, eliminating superfluous data, details about dates of examinations, confused or unconfirmed data. If there are several cases, they should be reported sequentially. Any indication that could identify the patient should be suppressed. The report should contain demographic data (age, weight, gender, race, occupation), clinical history, physical examination and altered complementary examinations, in concatenated and complete sentences and paragraphs, without truncated or loose information. Daily progress, consultation-liaison and normal routine exams should be avoided. The author should establish a temporal and causal relationship with the reported situation. Dates of reference or occurrence of events should refer to hospitalization or main intervention. Birth date or date when the care was provided should be avoided (Suggestion: '... 5 years before the procedure, the patient started presenting...').

The following adjectives should be avoided when qualifying procedures or examinations: 'detailed', 'careful', 'exhausting', since the reader assumes this is the standard procedure.⁷ Results of examinations, procedures and necropsy should not be fully transcribed, but only bring the most important information to interpret each case. Negative clinical or laboratory examinations should be included when they are absolutely necessary to understand the case.^2,7 Drugs should be mentioned according to their commercial name, name of laboratory and period of time since last dose. Their possible side effects and interactions should also be reported. In case of surgical technique, it should be described in sufficient detail to allow its reproduction by the reader.

Discussion should emphasize priority and singularity of the case, diagnosis accuracy and its validity compared with data from the literature, and subsidies to raise new perspectives, applications or knowledge. The author should briefly describe data from the literature, comparing and evaluating contrasts and nuances with the case reported. If there are too many articles, they can be briefly summarized in comparative tables to facilitate understanding (the details of each article should actually be the object of another type of publication, such as review articles).² The authors should have full versions of all the articles mentioned in the article, so that errors and omissions made by other authors are not reproduced.

Finally, the main aspects of your case should be summarized, besides justifying its singularity or rarity, suggesting recommendations, and indicating conclusions. The author should be careful in the conclusion, since it is only one or a few reported cases, with no statistical power to establish strong scientific evidence.¹

Therefore, case reports are a form of scientific presentation that are quite simple and important to be included in medical journals. J Vasc Bras is open to this type of publication, and the Editorial Board usually performs a careful evaluation of this type of contribution by authors. We reinforce the invitation made to SBACV colleagues and invite our colleagues from other Vascular Societies, especially in Latin America, to send their works to our journal.

References

1. El Dib RP. Como praticar a medicina baseada em evidências. J Vasc Bras. 2007;6:1-4.

2. Cohen H. How to write a patient case report. Am J Health Syst Pharm. 2006;63:1888-92.

3. Gottlieb GJ, Ragaz A, Vogel JV, et al. A preliminary communication on extensively disseminated Kaposi's sarcoma in a young homosexual men. Am J Dermatopathol. 1981;3:111-4.

4. Volodos' NL, Shekhanin VE, Karpovich IP, Troian VI, Gur'ev IuA. [A self-fixing synthetic blood vessel endoprosthesis]. Vestn Khir Im II Grek. 1986;137:123-5.

5. Galego GN, Silveira PG. Endopróteses revestidas. In: Maffei FHA, Lastória S, Yoshida WB, Rollo HA, organizadores. Doenças vasculares periféricas. 3ª ed. Rio de Janeiro: Medsi; 2002. p. 891-8.

6. Yoshida WB. A redação científica. J Vasc Bras. 2006;5:245-6.

7. Sauaia N, Sauaia MA. Redação do trabalho científico. V- Apresentação de caso. Arq Bras Cardiol. 1983;40:229-31.