Time for a new approach to case reports

Time for a new approach to case reports Case reports are popular and represent one of the oldest levels of evidence.Despite this they have attracted much criticism.They can be trivial, their conclusions do not usually undergo further investigation, and they are often questioned as a poor excuse for an unstructured review of the literature.Lessons from the past have given strong warnings against using new drugs based solely on case reports, such as the long-term adverse consequences of fetal exposure to diethylstilboestrol (DES) in pregnancy. 1Case reports are often not cited and hence many journals routinely reject them to protect their impact factors.Indeed, there is evidence that the prevalence of these articles in high impact journals is in decline. 2 Many journals have reconsidered their policy towards case reports over the years 3,4 and there has been a recent vogue in new journals publishing exclusively case reports, 5-7 one of which is no longer active. 8The International Journal of Surgery (IJS) has had dissonance towards case reports since its launch in 2003.Numbers steadily rose until they formed over a quarter of submissions in 2007.Under the weight of these submissions we chose to institute a policy of non-acceptance in late 2007, our instructions to authors were updated and many enthusiastic authors were rejected.Despite this, case reports have continued to be submitted in large numbers.We tentatively started to accept case reports again in mid-2009 with the bar set very high on quality and novelty.We feel the time has now come for the first dedicated home for such articles -International Journal of Surgery: Case Reports (IJSCR).The journal is due for launch on the 20 May 2010 and the IJS itself will no longer accept case reports from this point forward.This editorial provides a synoptic exposition for this major change in direction and its underlying rationale.Cliniciansand surgeons in particularlearn from stories, anecdotes and patient-based learning.Such learning has been essential to the advance of healthcare. 9Clinical knowledge is remembered far more efficiently when tagged to real-life events; this is perhaps to be expected amongst human beings working in such a highly organised social environment.Case reports can be very sensitive at detecting novelty.By definition, the discovery of every new condition, be it AIDS, SARS, Swine Flu or the next emergent disease begins with a single case.They complement evidencebased medicine, the learning of which should be drawn from a broad range of sources.A recent study of drugs withdrawn from the market found the scientific evidence for 19 out of 21 drugs came from spontaneous case reports. 10,11Case reports were the sole evidence in 12 and a randomized controlled trial (RCT) was only responsible for one.