CARE Guidelines
When written without reporting guidelines, case reports are often insufficiently rigorous, failing to provide sufficient information to guide implementation in clinical practice or replication in research. [Kaskin-Bettag 2012, Richason 2009] Since the mid-1990s, almost 400 health research reporting guidelines or extensions have been created for a variety of study designs; many are listed on the EQUATOR Network. These include the first reporting guidelines for randomized controlled trials – CONSORT, [Schulz 2010] observational studies – STROBE, [von Elm 2007] case reports — CARE [Gagnier 2013] systematic reviews and meta-analyses – PRISMA, [Moher 2012] and qualitative studies – COREQ and SRQR. [Tong 2007, O’Brien 2014] When medical journals endorse reporting guidelines, the completeness of published trials has increased. [Turner 2012]
The CARE guidelines (CAse REport) were developed by a group of experts following the “Guidance for Developers of Health Research Reporting Guidelines” [Moher 2010] to facilitate the publication of accurate, complete, and transparent case reports. The process included: (1) a literature review, followed by expert interviews to generate items for a case report checklist, (2) a face-to-face consensus meeting for drafting the CARE guidelines, (3) pilot testing, and (4) finalization, publication, and dissemination. The guidelines were presented at the 2013 International Congress for Peer Review and Scientific Publication sponsored by JAMA and the BMJ in Chicago, IL and simultaneously published in seven medical journals.
The CARE guidelines checklist. The checklist provides a list of items to include in a case report. Items that are important for high-quality case reports include:
A timeline in the form of a table or figure highlighting milestones from the episode of care. This may include family and medical history, genetic information, current symptoms, diagnostic test results, interventions and events that occurred during follow-up. The timeline should serve as a blueprint to the case report.
Diagnostic assessments and therapeutic interventions with specialty-specific information that provide information on clinician methodology.
A patient’s perspective on his/her/their experience which makes for a more convincing case report. Inclusion of patient-reported outcomes measures (such as PROMIS) and experiences that support patient-centered care.
Patient informed consent includes the opportunity to read and approve case report content.
The CARE Guidelines, first published in 2013, have subsequently been translated into 10 languages and endorsed by multiple medical journals and publishers. A 2017 publication — CARE guidelines for case reports: explanation and elaboration document — serves as a manual for writing case reports. It is useful for authors, editors, and peer reviewers. The Guidelines are listed on the EQUATOR Network – an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting, and wider use of robust reporting guidelines.
Case reports that are rigorous in their organization and presentation have made medical history and continue to improve medical care. Please let us know how your use of the CARE Guidelines helps you organize and write your case report.
Also take a look at our Course on Case Report Writing – comprehensive training for writing your case report, based on the CARE Guidelines and developed by David Riley, MD. The course consists of 12 lectures and videos, with nearly sixty handouts to download and guide you in writing your case report. Click the button below to learn more and to enroll.