Improving the quality and transparency of prehospital case reports using CARE

Clinical case reports have a long history in medicine. The earliest known examples date back to ancient Egypt (Nissen and Wynn, 2014a), and remain important in supporting contemporary, evidence-based healthcare (Akers, 2016). A case report is defined as a detailed narrative that describes, for medical, scientific or educational purposes, a clinical problem experienced by one or more patients (Gagnier et al, 2013). Published case reports have been central to the early discovery of previously unknown significant public health concerns, including HIV/Aids (Centres for Disease Control and Prevention, 1981), and congenital abnormalities associated with thalidomide use in pregnancy (McBride, 1961).

While considered a low-level form of evidence in the evidence-based practice hierarchy, there are many advantages in the use of clinical case reports (Box 1). Although limited in their generalisability, they are a flexible, credible and relatively straightforward way to develop a body of knowledge. They make use of naturally occurring data to produce a complete picture of a care encounter. When research on a topic is limited and more robust evidence is unavailable, a clinical case report may be the best available evidence to inform clinical practice and guidelines, especially for rare or unusual presentations (Scott, 2009). A clinical case report may provide a new perspective or advance the understanding of a well established concept (Aronson, 2003).