Writing a Case Report

Below are general formatting guidelines; however, you should also review journal-specific submission guidelines and several examples of case reports from your target journal in order to fully familiar with the format of published case reports in that journal.

1. General formatting guidelines:
   • typed using Microsoft Word; 12-point Times New Roman font
   • formatted with margins set at 1" for top and bottom and 1.25" for left and right
   • double-spaced, following the target journal’s guidelines and specifications
   • carefully checked for spelling, grammar, and punctuation
2. Specific formatting guidelines:
   • Final case report must conform to the style format and guidelines specified by the target journal’s submission guidelines (e.g., American Medical Association Manual of Style, Publication Manual of the American Psychological Association).
   • In addition to the hard copies of the various manuals of style, such as the American Medical Association Manual of Style, Heritage College students should be able to access the clinical campus’ medical library, as well as websites that offer explanations of these styles. A helpful resource is listed below as an example.
   • The International Committee of Medical Journal Editors (ICMJE) website contains the complete, most up-to-date version of Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication. This is very similar to AMA style, and virtually all medical journals will accept manuscripts following this style. http://www.icmje.org/about-icmje/faqs/icmje-recommendations/
3. The case report may include a combination of the following components:
   • Title Page
     • Title:  This should concisely convey the focus of the report.
     • Author Names and Affiliations:  Heritage College students should use their Heritage College affiliation details rather than the affiliation details of their clinical site and/or the affiliation details of their mentor (if different from HCOM/Ohio University).
     • Abstract (if required):  This should be one paragraph, typically not exceeding 125 words.  It is important to note that some journals do not require an abstract as part of a case report.
     • Key Words:  These should be MeSH (Medical Subject Headings) terms.
   • Body
     • The inclusion of appropriate headings should follow rules and example case reports from the target journal.
     • Introduction:  This establishes framework of patient case.
     • Case Report:  This includes the chief complaint; history of presenting illness; pertinent family history, risk factors, review of systems and pertinent clinical, physical, structural, and pathological findings; diagnostic studies; differential diagnosis; rationale for concluding clinical diagnosis; preferred, actual, and alternative treatment as appropriate.
     • Discussion:  This includes the etiology and review of current related literature supporting or refuting diagnosis; plan of treatment; and appropriate osteopathic components, minority health issues, patient safety issues, and complementary and alternative medicine issues.
     • Comments:  This should be a summary of the most important aspects of patient care and medical significance or direction for further study.
   • References
     • Some journals will restrict the number of references that may be used in a case report.
   • Relevant Figures
     • Charts, graphs, illustrations, diagrams, or tables should be included on separate pages at the end of the article, with legends; some journals will limit the number of these in their submission guidelines. Some journals will specify that photos be included with the submission (e.g., dermatology cases).

Case reports typically discuss a single patient.  General guidance from Ohio University IRB is that a case report for less than three patients is not considered to meet the definition of research designed to contribute to generalizable knowledge and therefore, does not require IRB approval.  However, if the case-based paper/case report is for more than three cases, IRB review and approval will be required.  It is important that you consult with the IRB in the institution in which you are conducting the case report to determine whether or not they require IRB review/approval.    

Permission from the patient to use their data for a single case report is a basic ethical tenet.  Consent or permission from a patient could be obtained verbally or in writing and documented with the case report data.  The information given to the patient should include a brief discussion of the case, the purpose, and that specific identifying information (such as name, birthday, address, etc.) will not be used but someone may be able to identify the patient because of this rare condition.  If appropriate, a copy of the report should be shared with the patient.  The journal to which you submit your case report may request proof that consent from the patient was obtained.  You should be able to produce documentation that you obtained consent from the patient or justification why consent could not be obtained.  If you have questions, you should contact Ohio University IRB at compliance@ohio.edu.

If required by the clinical campus, consent for the release of information from the patient should be obtained prior to writing the paper.

Case Report Consent Template

1. Relevant information on writing case-based papers can be found in the following journal article: Rison: A guide to writing case reports for the Journal of Medical Case Reports and BioMed Central Research Notes. Journal of Medical Case Reports 2013 7:239. 
2. The CARE Guidelines provide guidance on writing case reports and provides a checklist that explains what information you should collect and include in your case report.
3. Identify a case. If you are a medical student, you may not yet have the clinical expertise to determine if a specific case is worthy of a case report. You should seek the help of your mentor, preceptor, or another clinician to make this determination. It is common for students to ask attendings or residents if they have any interesting cases that can be used for a case report. 
4. Select a journal or two to which you think you will submit the case report. Your mentor or preceptor should be able to provide some suggestions. Journals often have specific requirements for publishing case reports, which could include a requirement for informed consent, etc. Journals may also charge publication fees (see Does it cost to publish? below).

Once you have identified the case, selected an appropriate journal(s), and considered permission from the patient or consent, you can collect the required information to write the case report.

Once a case has been selected, you must determine what audience would find the case useful. Once the audience has been identified, you must select a target journal as a potential venue for publication of the case report; it may be helpful to identify a few target publications and discuss these with your mentor or preceptor. The case report must then be written to conform to the submission guidelines and specifications of the specified target journal.

If you need to select on your own, here are some strategies:

1. Do a PubMed search
   • Search for a topic, disease, or other feature of your case report.
   • When the results appear, on the left side of the page is a limiter for "article type". Case reports are an article type to allow you to limit your search results. If you do not see that option on the left, click "Additional filters".
   • Review the case reports that come up from your search and see what journals in which they are published.
2. Use JANE (Journal/Author Name Estimator)
3. Search through individual publisher journal lists. Elsevier publishes many different medical research journals, and they have a journal finder, much like JANE. This database is exclusive to Elsevier journals. There are many other publishers of medical journals for review, including Springer, Wiley, Sage, Nature, and many others.

Once you have written a draft of the case report, you should seek feedback on your writing from experts in the field (e.g., your mentor or preceptor) or from those who have written and published case reports before.  

Heritage College students must cite their affiliation with the Ohio University Heritage College of Osteopathic Medicine on any dissemination activities (e.g., posters, publications).

Be aware that it may not be free to publish your case report.  Many journals charge publication fees.  Of note, many open access journals charge very large author fees.  Other journals have smaller page charges, and others will publish for free, with an "open access option".  It is best practice to check the journal's Information for Authors section or Author Center to determine what the cost is to publish.

The Research Publications Support Program, funded by the Heritage College of Osteopathic Medicine Office of Research and Grants (ORG), assists Heritage College faculty, staff, and students to disseminate their research through the publication of scholarly work.  This program covers, in part, funds for the publication fee of manuscripts that have been accepted for publication in PubMed indexed or comparable databases.  It does not support nonacademic or textbook publications, manuals, or fees from for-profit publishing organizations.  Manuscripts planned to be submitted for publication are not eligible.  Match support is limited to $500 per faculty/staff member or student per fiscal year (July 1-June 30), pending availability of funds.  The $500 limit per fiscal year may be split to be used for more than one publication.  Additional information and application details can be found on the Funding Opportunities webpage.

If Heritage College students in their third or fourth year of medical school training are interested in pursuing a case series (e.g., the review of greater than three cases), students should consider developing the project in the context of a research rotation, OCOM 8944 (Original Research).  For additional activities related to the development of case-based studies, third- or fourth-year medical students are encouraged to consider OCOM 8943 (Case-Based Research).  Please contact traineeresearch@ohio.edu for additional information related to these elective research rotations.