How to write a case report quickly, efficiently and get it published

How to write a case report

Prof Judy Savige

The University of Melbourne

Department of Medicine (MH and NH)

How to write a case report

quickly, efficiently and get it published

Prof Judy Savige

The University of Melbourne

Department of Medicine (MH and NH)

Case reports are valuable

• Case reports are experiments of nature,

valuable if they teach us something

• Contribute to our medical knowledge

• May be novel or contain a ‘teaching point’

• ‘Never drop off your CV’, help throughout career

• How we learn to write and publish

• A thrill for us to explain and describe something

for first time

What we should publish

• Manuscripts with at least one novel observation or

interpretation

– New clinical feature, association for a syndrome

– New temporal sequence that suggests a cause

– Medication – new, important side-effect, interaction or

response

• A teaching point ‘Common cases that present a

diagnostic, ethical or management challenge, or

indicate a mechanism of injury, pharmacology or

pathology’

Novel observation

• Lupus anticoagulant and thrombosis in ANCA-

associated vasculitis

• A 70 year old man with GPA and C-ANCA, who was

treated and 2 years later developed a venous

thrombosis and lupus anticoagulant when C-ANCA

was undetectable

• Novel points

– Association of ANCA with lupus anticoagulant

(anticardiolipin antibodies were already reported)

– Antibody and thrombosis developed years after vasculitis

presentation, inactive vasculitis

Novel observation

• ANCA and vasculitis developed after staph wound

infection

• Patient in hospital with AMI, CABGs, developed

sternal wound infection; urine microscopy and renal

function became very abnormal, ANCA became

detectable over 6 weeks

• Novel point

– Temporal sequence suggested a role of staph

infection in the development of ANCA (nasal staph

already implicated in ANCA vasculitis)

Novel observation – case series

• AntiGBM disease with normal renal function

Is this worth writing up?

• Present patient at a unit meeting or Grand Round –

find out if observation is novel or a suitable teaching

point before doing all the work for a manuscript

• Undertake a literature survey

• Talk to your local experts

• There will often be subtle differences from previous

reports – but reconsider if lots of similar patients

• Does not have to be a giant step for humankind!

Where should you publish?

• Be strategic

• Aim for an international journal

• Difficult to publish in some Australian journals

• BMJ case reports – online, publishes quickly and free

to access. You have to pay to publish but many

hospital libraries have a subscription for publishing

• High acceptable rate – 2/3 submissions (better than

most)

• http://casereports.bmj.com

• BMJ case reports are especially interested in

teaching points

Format of manuscript

• Similar for all journals

• Signed Consent form from the patient

• Title page – title, authors, contact details, short title,

corresponding author

• Abstract – keywords

• Introduction

• Case study

• Discussion

• Acknowledgements

• Conflicts of interest

• List of Tables and Figures

• References – Endnote

• Tables and Figures

A model for your paper

• Ask for help from a consultant who has seen the

patient and writes a lot with registrars

• Choose the journal you will submit to

• Find similar manuscripts in this journal and use them

as models

• Get all your results together

• Complete your literature search

• Work out your ‘angle’

Writing up

• Get your radiology and histology figures if

appropriate

• Write the case report as if you are presenting it to a

unit meeting

• Write Introduction and Discussion together (bits are

interchangeable)

• Write Abstract last since you know by then what you

want to say

Discussion

• Useful to use headings in your draft to tell story

• Discussion

– Start 1st paragraph with most important conclusions

– Dissect out the message

– Compare results with previous reports

– Deal with any problems eg missing results

– What are the implications

– What is the teaching point?

Extra bits

• Visual summary

• Three to five summary points

• Cover letter to the Editor

• why your manuscript is important

• that all authors approve this version

• that they have no financial or other Conflicts of

Interest

Some tips

• Highlight the novelty or teaching value

• Be as concise and clear as possible

• Use as few abbreviations as possible

• References – reference the first time a phenomenon

was described not the last time you found it or review

• Keep Tables to a minimum

• Do not repeat text in body of manuscript and in Table

Don’ts

• Don’t say “this is the first time this has been demonstrated”

• Don’t say “this is the first time in Australia”

• Don’t give an historical perspective

• Don’t use previous authors’ names in sentences. “Dr Green

demonstrated fewer leaves in Winter; Dr Brown showed

more leaves in Spring” This detracts from the impact.

Summarise the relevant points from previous publications.

• Don’t reference something we all know “Humans have two

kidneys”

• Don’t refer to ‘case’ rather “a patient/person/individual with

a disease”

Clear writing

• Be clear. Aim to have the reader understand and

remember what you have written

• We describe a disease in a certain sequence.

Prevalence, cause, clinical features, treatment…

• Use as few words as possible

• Writing is very formal. Some words are never used

• Use Australian/British spelling – the journal will

change it if necessary

• Use the past tense to describe what happened

Authorship

• The person who does most work is first author

• The senior consultant who helped you most is last

author

• Include other people whose contributions were

critical – other consultants, radiology (if they

provided Xrays etc)

Writing takes a long time

• Writing takes MUCH longer than you expect

• Write, rewrite and rewrite

• Leave your final draft for a week and go back to it for

final changes

• The better your final version, the less work for your

consultant, and the sooner manuscripts will be

submitted

Unusual clinical photograph

• Radiology, histology or retinal photograph or all

three

• Less work than a case study, can be published in high

ranking journal

• Will need to be highly novel or have a teaching point

Submission

• Author instructions are subtly different for each

journal

• Reference format differs for each journal

• Almost always online submission

• All authors must agree to this version

Making sure paper gets written

• You need to be in charge. One person does nearly all

the work and not everyone can write

• Make a deadline for changes to the final draft from

the other authors with the understanding that if they

don’t get back to you, they consent to submission

Rejection

• Often the decision sounds like a rejection but is

actually saying that the journal will accept the

manuscript if you make the requested changes

• If your manuscript is not accepted, you can argue

with the editors! Many do

• Consider the reviewers’ comments, change your

manuscript, send to another or more specialised

journal

• Maybe resubmit as a letter. A letter is less work, and

better than no publication at all! However the

acceptance rate may be low