Writing a Case Report

Although there are a multitude of ways to format case histories, I am presenting what has worked for me, as a template for prospective authors of such papers. This is intended to be non-confining and facilitative only. Ultimately the best format for writing a Case Report is to follow the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals” rules. This can be found in its entirety at:http://www.icmje.org/

This site contain links to Web sites which provide instructions to authors for over 3,000 journals in the health and life sciences, chiropractic included. For those who do not have Web access, contact with the librarian at a chiropractic college in your region can be very useful.

The “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”can also be found in the “Instructions for Authors” section in the beginning of any recent Journal of Manipulative and Physiological Therapeutics.

There is an excellent site that lists the chiropractic related peer reviewed journals along with each journals link and instruction for authors. It is as follows:http://www.chiroindex.org/open-access-library/peer-reviewed-journals

Typical Case Report Format

I. Title Page

This lists the title, author(s) address, and methods of contact.

II. Abstract and Key Word Page

A. The abstract creates a summary for your paper and is usually around 150 – 250 words. There are specific formats for an abstract and each journal has their particular preference. Information for what is needed to write “Structured Abstracts for Case Reports” is located here.

You can also find the article entitled, “Structured Abstracts for Case Reports”, in the Mar/Apr 1993 edition of Journal of Manipulative and Physiological Therapeutics, vol. 16, no. 3.

B. Keywords are usually key words or phrases that an indexer can use to cross-index your paper. It is best to use Index Medicus Medical Subject Headings (MeSH). To find the MeSH terms you may want to contact a librarian or explore on-line:http://www.nlm.nih.gov/mesh/meshhome.html

There is a new version of ChiroSH (chiropractic subject headings) which was edited by Ann Kempke (Northwestern Health Sciences University) and Bethyn Boni (New York Chiropractic College) that is now available. These additional subject headings can fill in gaps commonly left out by MeSh terms.http://www.chiroindex.org/htmls/ChiroSH2006.pdf

III. Introduction
A. Opening Statement

In the opening statement you present the topic you will be discussing and the purpose of your case report. This section is used to suggest to the reader what is about to come and why it is important to them. In this section it is also important to explain why this paper is being written. (1 – 2 paragraphs)

B. Current Accepted Allopathic or Traditional Approaches to Treatment.

This sections presents traditional approaches commonly found in mainstream medical literature. An example might be found in a book like “The Merck Manual”. It is necessary to reference discussions, minimizing the use of books, which are not peer reviewed and are considered to possibly be biased. A medline search for articles that give a basis for your position will often be quite helpful and productive. (3 – 10 paragraphs)

C. Research Supporting Chiropractic’s Treatment of Presenting Condition.

In this section a search of Medline and Mantis’ site on your topic’s chiropractic, osteopathic, or other alternative methods of treatment can be discussed. It is useful to focus both upon peer reviewed chiropractic studies and when necessary explore books, proceeding from conferences and whatever else is available related to your main topic. (3 – 10 paragraphs)

IV. Case Report
A. The Patient’s Presenting Symptoms
B. Examination Findings (MRI, Neuroconductive Studies, specialized studies, etc.)
C. Treatment Rendered
D. Results of Treatment and Follow-up Studies
V. Discussion
A. Reproducible Description of Method(s) of Care Used in this Case History

This section describes in detail the treatment rendered, in a way that makes it possible for the reader to reproduce your treatment. It is important to reference, if you can, the techniques and treatments to published papers or, if necessary, the books in which the technique is presented. (3 – 10 paragraphs)

B. Rationale for the Particular Method(s) of Care Used with this Patient

This section provides the rationale behind the method of treatment rendered, and includes presentation of the research — the anatomical, physiological, neurological, etc., explanations of treatment protocol choices. References supporting those assertions are essential so that they do not appear to have been completely baseless. (3 – 10 paragraphs)

VI. Conclusion

A. This section sums up the paper in a few sentences and then also describes the purpose of the paper in one or two sentences.

B. It is proper rhetoric at this point to avoid drawing any conclusions other than the treatment rendered in this one case led to the positive or negative outcome. Usually this includes a suggestion that, based on this case history, further investigation into the condition presented in this study is needed. (1 -2 paragraphs)

VII. Acknowledgment Page

Here is where you can thank anyone related or assisting you with your paper. Be sure to provide written permission for any person to be mentioned in the acknowledgment.

VIII. Reference Page(s)

Each journal might have their own format; requirements for submission should be checked.

A. There are many on-line search engines but my favorites are for:

1. Medline Searches:a This site is free, except for downloading the article in its entirety.

2. MANTIS (Chiropractic and Allied Health Care) Searches: There is a charge for using Mantis but it is an unparallelled resource of chiropractic peer reviewed literature.

3. ChiroIndex.Org: (Chiropractic Based) Searches: A wonderful chiropractic search engine, with abstracts, chiropractic information, and FREE!

C. Telephone:

1. Most Chiropractic College Librarians are unbelievably helpful and capable of helping with literature searches.

2. Call SOTO-USA and you will be forwarded to someone who will try to help also at: (336) 793-6524

IX. Table, Legends for the Illustrations, and Illustrations Page(s)
X. Patient Consent Form

Believe it or not but as attempts are being made to protect patient identity more and more journals are requesting signed patient consent forms before accepting case reports for review and publication. For help please download the following consent forms:

At this point the author may want to again look at the journal submission requirements, check with the journal editor, or speak with someone associated with journal submissions. Generally, everyone is more than happy to help. New writers are usually encouraged, assisted and welcomed.

More Information

A good guide to writing case reports from start to finish and extremely helpful:

Green BN, Johnson CD. How to write a case report for publication. J Chiropr Med. 2006 Summer;5(2):72-82.

ABSTRACT: This paper describes how and why to write a case report for publication in a peer-reviewed journal. Steps for preparing a case report are described based upon the current available literature. A self-evaluation check sheet for authors is included to assist in the writing process.

A recent excellent text by Matthew McCoy, DC, past editor of the Journal of Vertebral Subluxation, has been published, entitled:

The Case Study Report, The Individual’s Experience, Conceiving, Writing & Submitting Cases Studies on Chiropractic: A Step by Step Guide. “

From the Preface

This book is divided up into three parts or sections. The first part outlines the nuts and bolts of putting together a case study starting with a piece on why case studies are so important to the chiropractic profession. This is followed by detailed information on how to describe chiropractic interventions and the outcomes that result from the application of our science and art. Guidance on literature searching, putting together your references and what to expect during the peer review and publication process is also provided.

Part II takes you through an actual case study section by section and attempts to reinforce and give you an example of how a case study is built and what the end product looks like.

Part III is a series of articles that pragmatically explore the very serious situation that the chiropractic profession finds itself in when it comes to its research infrastructure and culture. Also included in this section is a paper by Dr. Christopher Kent on Models of Vertebral Subluxation which is important reading for anyone trying to describe subluxation related research findings. While Part III is the last section I strongly encourage the reader to review this section first before tackling the nuts and bolts of putting together a case.

Case Study Research Methods Courses

From some basic guidance and tutorials that walk you through the process, to comprehensive one on one coaching, support, editing and instruction – Dr. Matthew McCoy has a program that will help you turn your miracles into a case study research report.

Why it is Important to Write a Case Report

Most persons believe that the case report is used to describe unique, or at least highly rare, clinical presentations or diagnostic entities (e.g.,”prostatic hypertrophy mimicking as ingrown toenail”). This is the most common use of the case report. However, equally important is the use of the case report to describe novel management approaches to more ordinary conditions.

Another aspect of why case reports are written involves the audience. Case reports are generally considered as a communication from clinicians to scientists. The pointy-headed ivory tower population doesn’t get to see the interesting things that happen in clinical practice. They often rely on case reports from the field in deciding what sorts of pilot studies to run, and those often lead to real full-scale clinical trials (the sort of research that field clinicians generally don’t have the time, resource or interest to undertake).

Case reports are a vital aspect of our literature base, and more of our practitioners need to write them. Until you write up that wonderful method that works in your office, the rest of the world cannot share in its benefits. Without publication, when you die or retire, your discoveries die with you.

Robert W. Ward, D.C., FAFICC
Editor, Journal of Chiropractic Education

See Also

Merritt L. Case reports: an important contribution to chiropractic literature. Journal of the Canadian Chiropractic Association. Jun 2007; 51(2): 72-4.

A Note from the Author

The author encourages direct contact, and offers "help in any way" to those interested in publishing, particularly if the study is related to Sacro Occipital Technique.

He can be reached as follows:
Charles L. Blum, DC, CSCP
Mail: 1752 Ocean Park Boulevard
Santa Monica, California 90405
Telephone: (310) 392-9795
Email: DrCBlum@aol.com

Case Report “Fill-in the Blanks” Checklist

This free Word Document makes it easy to just fill in the blanks and then your have the structure for a good case report.

Just click on the following link:
Case Report CheckList