Improving the quality and transparency of prehospital case reports using CARE

02 September 2019
Volume 9 · Issue 3


Clinical case reports play an important role in supporting evidence-based paramedicine. When research on a topic is limited and there is no robust evidence, a case report may be the best available, especially for rare or unusual presentations or in novel clinical practice. Case reports in paramedicine journals are common. However, adherence to the published consensus-based reporting guideline is rare, which may weaken the evidence arising from this body of case report literature. There is a need for greater awareness of the structured reporting guideline for case reports, and for the development of a paramedicine-specific extension. The objectives of this paper are to: describe the current state of case reports in paramedicine; promote the adoption of an internationally accepted, consensus-based reporting guideline; and propose an extension to that guideline, adapted to the unique characteristics of prehospital practice.

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).

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