How to write a publishable case report using the CARE guidelines

Case reports are often the first publication of a clinician's career, and for good reason: they come straight from clinical practice, need no funding and can be written in weeks. They are also rejected frequently, usually not because the case is uninteresting but because the report does not make its lesson clear, leaves out information a reader needs, or lacks consent.

The CARE guidelines (CAse REports), published in 2013 and endorsed by many journals, give a checklist for what a case report should contain. This guide walks through it section by section.

Before you write: is the case worth reporting?

Write down, in one sentence, what a reader will learn from your case that they did not know before. If you cannot, the case probably is not ready. Strong case reports usually fall into one of these categories:

• An unusual or atypical presentation of a known disease that could lead to misdiagnosis
• A rare disease, with a diagnostic or management lesson rather than rarity alone
• An unexpected adverse drug reaction or drug interaction
• A novel or unusual use of an existing treatment, with a documented outcome
• A diagnostic or therapeutic dilemma with a transferable lesson

Search PubMed for similar cases before writing. If dozens already exist, your report must add something they do not, and your discussion should say what.

The CARE checklist, section by section

Title and keywords

Include the words "case report" and the key element of interest (the diagnosis, intervention or adverse event). Choose two to five keywords that a clinician would actually search.

Abstract

Summarise the introduction (why the case matters), the case (main symptoms, findings, diagnosis, interventions and outcome) and the conclusion (the main lesson). Many journals limit case report abstracts to 150–250 words.

Introduction

One or two short paragraphs explaining the background and why this case is unique or instructive, with a few key references. Avoid textbook descriptions of the disease.

Patient information

De-identified demographics (age, sex, relevant occupation), main symptoms, medical, family and psychosocial history, and relevant past interventions. Never include names, initials, hospital numbers or dates that could identify the patient.

Clinical findings

Relevant physical examination findings, in enough detail that a reader can follow the diagnostic reasoning.

Timeline

CARE asks for a timeline of key events: symptom onset, presentation, investigations, diagnosis, interventions and follow-up. A simple table or figure is often the clearest format and is one of the most frequently missing items.

Diagnostic assessment

Investigations with results (and reference ranges for laboratory values), diagnostic challenges such as access or cost, the differential diagnosis considered, and the final diagnosis with any prognostic characteristics.

Therapeutic intervention

Types of intervention (pharmacological, surgical, preventive), with dose, route, frequency and duration, and any changes with the reasons for them. Use generic drug names.

Follow-up and outcomes

Clinician-assessed and patient-reported outcomes, results of follow-up tests, adherence and tolerability, and any adverse or unexpected events. State the duration of follow-up.

Discussion

The strengths and limitations of your management, a focused comparison with relevant published cases, the rationale for your conclusions and the take-away lesson. Avoid claiming causation that one case cannot establish; say "may" and explain alternative explanations.

Patient perspective

Where possible, include the patient's own account of the experience. It is optional in many journals but valued.

Informed consent

State that written informed consent for publication was obtained. Without it, most journals will not proceed.

Images and figures

Clinical photographs, imaging and histopathology often carry the main message. Crop or mask anything identifying (faces, tattoos, names on scans), add scale bars to microscopy, use arrows to direct attention and write legends that stand alone. Obtain specific consent for any image in which the patient could be recognised.

Why case reports get rejected

• No clear lesson: the report describes the case but never says why it matters
• Missing consent statement or patient-identifying details
• No timeline, so readers cannot follow the sequence of events
• Over-long introduction and discussion that read like a review article
• Causal claims that a single case cannot support
• Wrong journal: many journals no longer publish case reports, so check before submitting

Choosing a journal

Fewer high-impact journals accept case reports than in the past, but many reputable indexed journals do, including specialty journals and dedicated case report journals. Verify indexing yourself (see how to verify journal indexing), and be especially cautious of invitations promising rapid publication of case reports, a common approach of predatory journals.

Sources and further reading

• CARE case report guidelines and checklist
• EQUATOR Network
• ICMJE Recommendations on patient privacy and consent

Need help? Our scientific editing and reporting guideline review services check your case report against CARE and the target journal's requirements.