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.1 Case 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