The role of case reports in evidence-based practice, with suggestions for improving their reporting

Abstract

Background: Case reports are part of the evidence hierarchy in evidence-based practice and guide an important part of dermatologic practice.

Objective: This article discusses the role of case reports and series in evidence-based practice and suggests how to improve reporting.

Methods: This article was inspired by a forum on the role of case reporting in dermatologic practice presented at a meeting of the American Academy of Dermatology. It is based on an informal literature review and the authors' experience in systematically reviewing case reports in medicine and dermatology.

Results: Case reports significantly influence medicine. Often they are the first line of evidence for new therapies but rarely are sufficient to establish treatment efficacy. Frequently they are the first and sometimes major source for detecting rare adverse events. Guidelines for improving the reporting of case reports and series are discussed.

Limitations: This paper represents the views of the authors and is neither a systematic review of the literature nor a formal consensus document.

Conclusion: Case reports are an important part of medical literature and need to be taken seriously.

Fig 1

Myasthenia gravis treated with physostigmine by Walker. Reprinted from The Lancet, with permission from Elsevier.

Fig 2

Evidence pyramid. Adapted with permission from State University of New York Downstate Medical Center Medical Research Library of Brooklyn, New York. Available at: http://library.downstate.edu/ebmdos/2100.htm. Accessed March 7, 2008.