How to Write and Review a Case Report

 

The Principles of Medical Journalism: How to Write and Review a Case Report

A Practical Guide for Critical Care Trainees

Dr Neeraj Manikath , claude.ai

Abstract

Case reports remain a cornerstone of medical literature, serving as vehicles for documenting unusual presentations, novel complications, and innovative management strategies. For postgraduate trainees in critical care, publishing a well-crafted case report represents an achievable entry point into academic medicine while contributing meaningfully to clinical knowledge. This review article provides a comprehensive framework for identifying publishable cases, structuring manuscripts according to journal standards, conducting focused literature reviews, crafting compelling discussions, and navigating the peer-review process. We present practical "pearls and oysters"—helpful tips and common pitfalls—drawn from editorial experience and successful publication strategies. Understanding these principles transforms case documentation from routine clinical record-keeping into scholarly communication that advances the field of critical care medicine.

Keywords: Case report writing, medical journalism, critical care education, peer review, medical publishing

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Introduction

In an era dominated by randomized controlled trials and meta-analyses, the humble case report might seem antiquated. Yet case reports continue to occupy an essential niche in medical literature, particularly in critical care medicine where rare presentations, unexpected complications, and novel therapeutic approaches frequently challenge our understanding.[1,2] For postgraduate trainees, case reports offer an accessible pathway to publication, teaching skills in clinical observation, literature analysis, and scientific writing that prove invaluable throughout academic careers.[3]

The intensive care unit (ICU) environment presents unique opportunities for case report generation. The complexity of critically ill patients, the use of advanced monitoring and therapeutic modalities, and the convergence of multiple organ systems create scenarios unlikely to be captured in large trials.[4] However, merely encountering an interesting case does not guarantee publication. Success requires recognizing publishable elements, structuring the narrative effectively, contextualizing findings within existing literature, and navigating editorial processes with professionalism.

This article synthesizes best practices for case report writing, drawing from editorial guidelines, publishing standards such as the CARE (CAse REport) checklist,[5] and practical experience in critical care journalism. We aim to demystify the publication process and provide actionable strategies for trainees embarking on their first scholarly submissions.

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What Makes a Case "Publishable"? Rarity, Educational Value, and a Clear Message

The Three Pillars of Publishability

Not every unusual case warrants publication. Editors evaluate submissions based on three fundamental criteria: rarity, educational value, and clarity of message.[6,7]

Rarity alone insufficient for publication—what matters is meaningful rarity. A case might involve:

• An unprecedented complication of a common procedure
• An extremely rare disease presenting to the ICU
• A novel manifestation of a known condition
• An unexpected drug interaction with serious consequences
• A first report of a particular combination of factors

🔹 PEARL: Conduct a preliminary literature search before investing time in writing. If you find 50+ similar published cases, reconsider unless your case offers something substantially new.[8]

Educational value transforms a curiosity into a contribution. Ask yourself:

• Will this case change how clinicians approach similar situations?
• Does it highlight a diagnostic pitfall or therapeutic trap?
• Does it demonstrate an innovative management strategy?
• Could it prevent future morbidity or mortality?

A clear message distinguishes strong case reports from meandering narratives. Before writing a single word, articulate in one sentence what you want readers to remember. Examples:

• "Citrate toxicity from continuous renal replacement therapy can mimic septic shock and should be in the differential of unexplained hemodynamic instability."
• "Delayed hypersensitivity to propofol can present as fever and eosinophilia weeks after ICU admission, mimicking nosocomial infection."

⚠️ OYSTER (Pitfall): Avoid the "interesting case" without a takeaway. Cases that merely describe unusual presentations without offering clinical guidance rarely merit publication.[9]

Special Categories in Critical Care

Certain case types hold particular value in critical care literature:

1. Therapeutic innovations: Novel use of existing therapies (e.g., inhaled epoprostenol for right ventricular failure in a resource-limited setting)
2. Diagnostic challenges: Cases highlighting the limitations of current diagnostic criteria
3. Systems-level lessons: Cases revealing latent safety threats or communication failures
4. Resource-constrained solutions: Innovative approaches when standard therapies are unavailable
5. Pandemic-related presentations: New complications or management strategies for emerging diseases[10]

🔹 PEARL: For COVID-19 or other pandemic-related cases in the post-acute phase, ensure your case adds substantively to an already saturated literature. Focus on late complications, long-term outcomes, or management in special populations.[11]

The "So What?" Test

Before committing to writing, apply the "so what?" test:

• Specific: Can you define exactly what makes this case notable?
• Obvious: Is the learning point evident, or are you forcing significance?
• What changes: Will reading this case modify anyone's practice?
• Heard before: Has this lesson been published repeatedly?
• Applicable: Is this relevant beyond your specific institution?
• Timely: Is this addressing a current clinical need?

If your case passes most of these criteria, proceed with confidence.

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The STRUCTURE of a Case Report: Abstract, Introduction, Case, Discussion, Conclusion

Following the CARE Guidelines

The CARE (CAse REport) guidelines provide an evidence-based framework for case report structure.[5] Most reputable journals require adherence to these guidelines, which enhance clarity and completeness.

Abstract (150-250 words)

The abstract follows a structured format in most journals:

Introduction: One to two sentences establishing context and why this case matters.

Case Presentation: Concise summary of patient demographics, presentation, key findings, management, and outcome.

Conclusion: The take-home message and clinical implications.

🔹 PEARL: Write the abstract last, after the full manuscript is complete. This ensures consistency and allows you to highlight the most important elements that emerged during writing.[12]

⚠️ OYSTER: Avoid overpromising in the abstract. If you describe the case as "unprecedented," the literature review in your discussion must support this claim or reviewers will reject it immediately.

Introduction (200-300 words)

The introduction establishes the clinical context and justifies why this case deserves publication. Structure it as a funnel:

1. Broad context: The general clinical scenario or disease state
2. Narrowing focus: The specific aspect your case addresses
3. Knowledge gap: What remains unknown or controversial
4. Your case's contribution: One sentence explaining what this case adds

Example structure:

"Acute respiratory distress syndrome (ARDS) complicates approximately 10% of ICU admissions... [broad context]. Prone positioning improves oxygenation and mortality in severe ARDS... [narrowing]. However, optimal timing for prone-to-supine transitions remains debated... [gap]. We present a case where continuous monitoring with electrical impedance tomography guided positioning strategy, resulting in... [contribution]."

🔹 PEARL: Keep the introduction brief and focused. This is not a comprehensive review—save detailed pathophysiology for the discussion.[13]

⚠️ OYSTER: Avoid beginning with dictionary definitions ("Sepsis is defined as..."). Assume your readers are clinicians with foundational knowledge.[14]

Case Presentation (500-800 words)

This section narrates the clinical course in chronological order. Follow this framework:

Patient Introduction

• Demographics (age, sex, relevant ethnicity if pertinent)
• Presenting complaint and admission diagnosis
• Relevant past medical history (only what matters to the case)
• Baseline functional status

🔹 PEARL: Include a timeline figure for complex cases. Visual representations of clinical course, interventions, and laboratory trends enhance comprehension dramatically.[15]

Clinical Course

Organize by phases:

1. Initial presentation and assessment
2. Diagnostic workup with results
3. Management interventions
4. Clinical evolution
5. Complications (if any)
6. Outcome

Key principles:

• Report laboratory values with reference ranges
• Include only relevant investigations—resist the temptation to list every test
• Describe interventions with sufficient detail for reproducibility
• Note temporal relationships between interventions and clinical changes
• Use subsections for clarity in lengthy cases

Table Strategy: Use tables to present:

• Serial laboratory values over time
• Ventilator settings and respiratory parameters
• Antimicrobial courses
• Hemodynamic data

🔹 PEARL: When describing imaging findings, focus on abnormalities relevant to your case. For radiographs and CT scans, include images with arrows highlighting key findings. Always obtain patient consent and ensure proper de-identification.[16]

⚠️ OYSTER: Avoid subjective interpretations in the case description. Save "this suggests..." or "we hypothesized..." for the discussion. The case section should be predominantly objective.[17]

Outcome Statement

Conclude with clear outcome information:

• ICU and hospital length of stay
• Discharge disposition
• Functional status at discharge
• Follow-up information (if available and relevant)

Discussion (800-1200 words)

The discussion transforms your case from anecdote to scholarship. This section requires the most skill and is where many manuscripts falter.

Structure of an Effective Discussion

Paragraph 1: Summary and significance Briefly restate the case's essential elements and why it matters. One paragraph, 3-5 sentences maximum.

Paragraph 2-3: Literature review and case comparison

• How does your case compare to previously reported cases?
• What patterns emerge when considering the literature?
• How is your case similar and different?

Paragraph 4-5: Pathophysiology and mechanisms

• Explain the underlying pathophysiology relevant to your case
• Discuss proposed mechanisms supported by evidence
• Connect basic science to clinical observations

Paragraph 6-7: Management considerations

• Discuss therapeutic approaches, including alternatives
• Address why you chose your specific management strategy
• Acknowledge limitations or controversies

Paragraph 8: Clinical implications

• Practical takeaways for clinicians
• Suggested diagnostic or management algorithms
• Areas requiring further study

🔹 PEARL: Use the discussion to show expertise, not just summarize literature. Synthesize information, identify patterns, and propose frameworks that help readers approach similar cases.[18]

⚠️ OYSTER: Don't simply list previous case reports without analysis. Editors seek synthesis and insight, not literature cataloging.[19]

Limitations

Include a separate subsection (or concluding paragraph) acknowledging limitations:

• Single case experience (inherent limitation)
• Missing data or investigations
• Inability to establish causation
• Lack of long-term follow-up

🔹 PEARL: Frame limitations honestly but not apologetically. Every case report has limitations—acknowledging them demonstrates scholarly maturity.[20]

Conclusion (100-150 words)

The conclusion should:

• Reinforce the main clinical message (different words than abstract)
• Suggest practical applications
• Identify future research directions if appropriate

⚠️ OYSTER: Avoid introducing new information in the conclusion. No new references should appear here.[21]

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Performing a Lit Review: Finding the Relevant "Previously Reported Cases"

Search Strategy for Case Reports

A thorough literature review is non-negotiable. It prevents embarrassment (discovering your "novel" case has been reported 20 times), strengthens your discussion, and demonstrates scholarly rigor.

Databases and Resources

Primary databases:

1. PubMed/MEDLINE: The foundation for medical literature searches
2. Embase: Captures more international and non-English language journals
3. Web of Science: Useful for citation tracking
4. Google Scholar: Broader coverage but less curated

🔹 PEARL: Use multiple databases. PubMed alone misses approximately 20-30% of relevant medical literature.[22]

Search Terms Strategy

Develop a comprehensive search strategy:

Step 1: Identify key concepts

• Primary diagnosis/condition
• Key complications or features
• Therapeutic interventions
• Patient population

Step 2: Use Medical Subject Headings (MeSH) PubMed's MeSH terms standardize vocabulary. For example, searching "bloodstream infection" and "bacteremia" separately misses papers using alternative terminology—MeSH captures all.

Step 3: Combine with publication type filters

("Multisystem inflammatory syndrome"[MeSH] OR "MIS-C"[tiab]) 
AND 
("Critical Care"[MeSH] OR "Intensive Care Units"[MeSH])
AND
("Case Reports"[Publication Type] OR "case report"[tiab])

🔹 PEARL: Don't over-restrict initial searches. Cast a wide net first, then narrow based on results. Use Boolean operators (AND, OR, NOT) effectively.[23]

⚠️ OYSTER: Searching only "rare disease name AND case report" may miss the most relevant papers. Authors don't always label their paper as a case report in the title/abstract.[24]

Assessing Search Completeness

How do you know when you've searched sufficiently?

1. Saturation: You stop finding new relevant papers
2. Citation loops: References in recent papers cite papers you've already found
3. Key author identification: You recognize the same experts appearing repeatedly
4. Timeframe: Search at least 20 years back for rare conditions, 10 years for more common scenarios

🔹 PEARL: Use PubMed's "Similar articles" feature and citation tracking ("Cited by" links) to find related papers you might have missed with keyword searches.[25]

Organizing Your Literature

Create a structured database (Excel, EndNote, Zotero, or Mendeley) with:

• Author, year, journal
• Patient demographics
• Key clinical features
• Diagnostic findings
• Management approach
• Outcome
• Unique aspects

🔹 PEARL: A well-organized literature table becomes supplementary material for your manuscript and a valuable reference for discussion writing.[26]

The Summary Table

Most case reports benefit from a table summarizing previously reported cases:

Study	Year	Patient	Presentation	Management	Outcome
Author et al.	2022	45M	...	...	Recovered

This table:

• Provides readers with quick literature context
• Demonstrates thoroughness
• Facilitates comparison with your case

⚠️ OYSTER: Don't make the table overwhelming. Limit to 10-15 most relevant cases if dozens exist. Summarize the remainder in text ("27 additional cases reported between 1990-2010...").[27]

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The Discussion Section: Moving from Your Case to the Broader Clinical Lesson

The Art of Synthesis

The discussion distinguishes excellent case reports from mediocre ones. This section requires moving beyond description to analysis, synthesis, and clinical reasoning.

Framework: From Specific to General

Use an expanding framework:

1. Your specific case: Unique features and immediate observations
2. Similar cases: Patterns across reported cases
3. Broader literature: Evidence from case series, cohort studies, or trials
4. General principles: Clinical lessons applicable beyond the specific condition

Example progression:

"In our patient, lactic acidosis persisted despite adequate resuscitation and absence of tissue hypoperfusion markers [specific]. Review of 12 reported cases of citrate toxicity in CRRT reveals that 9 (75%) demonstrated unexplained metabolic acidosis despite normal perfusion [similar cases]. Citrate metabolism depends on liver function, and critically ill patients often have subclinical hepatic dysfunction that impairs citrate clearance [broader literature]. This suggests that unexplained acidosis during citrate-based CRRT should prompt consideration of citrate accumulation, particularly in patients with liver disease or shock [general principle]."[28]

Connecting Pathophysiology to Clinical Observations

Strong discussions link bedside observations to underlying mechanisms:

Template: "The clinical finding of [observation] in our patient likely reflects [mechanism], supported by [evidence]. This has implications for [clinical practice] because [reasoning]."

🔹 PEARL: Use figures or diagrams to illustrate pathophysiologic mechanisms. Visual representations enhance understanding and are highly valued by readers and editors.[29]

Addressing Differential Diagnosis

Discuss why alternative diagnoses were considered and excluded:

• What else could have caused similar findings?
• What clinical, laboratory, or radiologic features distinguished your diagnosis?
• What diagnostic criteria or scoring systems apply?

This demonstrates clinical reasoning and helps readers approach similar presentations systematically.

Management Rationale and Alternatives

Don't just describe what you did—explain why:

• Evidence supporting your approach
• Why alternatives were less suitable
• Timing considerations
• Risk-benefit analysis

🔹 PEARL: If you used an unconventional approach, provide strong justification. If standard therapy wasn't used, explain why (contraindication, unavailability, patient refusal).[30]

The "What Should Clinicians Do?" Section

Every discussion should culminate in practical guidance:

• Diagnostic algorithms or screening recommendations
• Management flowcharts
• Monitoring strategies
• When to consult subspecialists

Example:

"Based on this case and literature review, we propose the following approach when citrate toxicity is suspected: (1) Measure total and ionized calcium ratio (>2.5 suggests accumulation), (2) Check arterial pH and lactate, (3) Temporarily reduce citrate flow rate, (4) Consider switching to heparin anticoagulation if coagulopathy permits. Resolution of acidosis within 4-6 hours supports the diagnosis."

⚠️ OYSTER: Avoid overgeneralizing from a single case. Use phrases like "this case suggests..." or "our experience indicates..." rather than making definitive practice recommendations.[31]

Addressing Controversies

If your case touches on controversial areas:

• Present multiple perspectives fairly
• Cite high-quality evidence for each viewpoint
• Explain your position with rationale
• Acknowledge uncertainty where it exists

🔹 PEARL: Engaging with controversy demonstrates sophistication and makes your discussion more interesting. Don't shy away from it.[32]

Common Discussion Pitfalls to Avoid

1. Literature review as list: Simply enumerating previous cases without synthesis
2. Excessive tangents: Discussing interesting but tangentially related topics
3. Lack of critical analysis: Accepting all literature at face value without evaluating quality
4. Missing the forest for trees: Getting lost in details without extracting the main lesson
5. Overreach: Making broad claims unsupported by your single case[33]

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Navigating the Submission and Peer-Review Process

Selecting the Right Journal

Journal selection determines your manuscript's fate more than many authors realize.

Factors to Consider

1. Journal scope and audience

• Does the journal publish case reports in your subspecialty?
• Read recent issues—do they publish cases similar to yours?
• What is their stated case report policy?

2. Impact factor considerations

• High-impact general journals (NEJM, Lancet, BMJ) accept <1% of case reports
• Moderate-impact subspecialty journals offer better acceptance rates with good readership
• Open-access journals provide wider dissemination but may charge fees

🔹 PEARL: Don't aim too high or too low. If your case is truly extraordinary, consider high-impact journals. For educational cases with clear lessons, subspecialty journals are ideal.[34]

3. Practical considerations

• Submission to publication timeline (some journals take 12+ months)
• Open access requirements (funding availability?)
• Word count and reference limits
• Supplementary material allowances

Journal Tiers Strategy

Tier 1: Dream journals (major general medical journals) Tier 2: High-quality subspecialty journals (e.g., Critical Care Medicine, Intensive Care Medicine) Tier 3: Solid subspecialty or regional journals Tier 4: Open-access specialty journals

⚠️ OYSTER: Avoid predatory journals—those that promise rapid publication for fees with minimal peer review. Check the journal's indexing in PubMed and inclusion in the Directory of Open Access Journals (DOAJ).[35]

Pre-Submission Checklist

Before submitting, ensure:

Content completeness:

• [ ] Patient consent obtained and documented
• [ ] All author contributions justified
• [ ] Conflicts of interest declared
• [ ] Institutional review board approval (if required)
• [ ] CARE checklist completed[5]
• [ ] All references verified and formatted correctly
• [ ] Figures and tables properly labeled and cited
• [ ] Word count within journal limits

🔹 PEARL: Use the journal's author guidelines as a checklist. Most rejections for technical reasons stem from failure to follow basic submission requirements.[36]

Professional presentation:

• [ ] Manuscript proofread multiple times
• [ ] Co-authors reviewed and approved
• [ ] Cover letter drafted explaining significance
• [ ] Suggested reviewers identified (if requested)

The Cover Letter

The cover letter is your one chance to make a direct appeal to the editor. Include:

1. Opening: Manuscript title and type (case report)
2. Significance statement: 2-3 sentences on why this case is important and fits the journal
3. Novel aspects: What makes this case publishable
4. Confirmations: Ethics approval, patient consent, author agreement
5. Competing interest disclosure
6. Suggested reviewers (if requested): Propose experts not from your institution

🔹 PEARL: Keep cover letters concise (250-300 words). Editors review dozens daily—respect their time.[37]

Template:

"Dear Dr. [Editor],

We submit for consideration our case report titled '[Title]' for publication in [Journal] as a Case Report.

This case describes [brief case description] which is significant because [1-2 sentences on importance]. To our knowledge, this represents [unique aspect], and offers the clinical lesson that [key takeaway]. Given [Journal]'s readership of critical care practitioners, we believe this case will have immediate practical relevance.

All authors have approved this submission. Ethics approval was obtained from [Institution] (Reference #XXX), and written informed consent was provided by the patient. The authors declare no competing interests.

Thank you for your consideration.

Sincerely, [Corresponding Author]"

Understanding the Editorial Process

Initial Editorial Screening (1-2 weeks)

Editors perform quick assessment:

• Does this fit the journal's scope?
• Is it potentially publishable?
• Are there major formatting violations?

Outcomes:

• Desk rejection (~50-70% of submissions to competitive journals): Not sent for peer review
• Sent for peer review (~30-50%): Proceeds to external reviewers

🔹 PEARL: If desk rejected, the editor's feedback is valuable. If they indicate scope mismatch, don't resubmit to the same journal with minor changes. If they cite quality concerns, address them before submitting elsewhere.[38]

Peer Review (4-8 weeks)

Typically 2-3 reviewers evaluate:

• Scientific validity
• Clinical significance
• Literature review adequacy
• Writing quality
• Ethical considerations

⚠️ OYSTER: Long review times don't necessarily indicate rejection. High-quality journals often have backed-up reviewers.[39]

Responding to Reviewers

Decision Types

1. Accept (rare for first submission, <5%) 2. Minor revisions (~10-15%): Small changes, typically accepted after revision 3. Major revisions (~30-40%): Substantial concerns but potentially salvageable 4. Reject with invitation to resubmit (~10%): Fundamental issues requiring extensive work 5. Reject (~40-50%): Not suitable for the journal

Crafting Your Response

Golden rules:

1. Never respond emotionally or defensively
2. Address every comment, even if you disagree
3. Be respectful and appreciative
4. Make revisions clear

Response format: Create a point-by-point document:

Reviewer 1:

Comment 1: "The authors should include more detail about ventilator settings."

Response: We thank the reviewer for this suggestion. We have now added a table (Table 2) showing serial ventilator settings including mode, tidal volume, PEEP, and FiO2. Please see page 6, lines 143-147.

Comment 2: "The discussion of prone positioning timing is inadequate."

Response: We have expanded this section with additional references and analysis (page 10, lines 245-267). We now include discussion of the PROSEVA trial timing protocol and how our approach compared.

🔹 PEARL: Even if you disagree with a reviewer's suggestion, explain your reasoning respectfully. Editors value authors who engage constructively with feedback.[40]

When to disagree: You may respectfully disagree if:

• The suggestion would require data you don't have (explain why it's unavailable)
• The recommendation contradicts the journal's guidelines
• The reviewer misunderstood something (clarify politely)

Template for disagreement:

"We appreciate the reviewer's suggestion to [suggestion]. However, [reason you cannot implement]. Instead, we have [alternative action] which we believe addresses the underlying concern about [issue]."

⚠️ OYSTER: Never write "Reviewer 2 clearly didn't read our manuscript carefully" or similar confrontational statements. This virtually guarantees rejection.[41]

Handling Rejection

Rejection is common and does not reflect on your worth as a clinician or researcher. Studies show ~60-80% of case reports are rejected from first-submission journals.[42]

Post-rejection strategy:

1. Wait 24-48 hours before responding emotionally
2. Analyze feedback objectively: Are there valid concerns to address?
3. Decide: Revise and resubmit elsewhere, or abandon this case?
4. If resubmitting: Incorporate feedback and choose a more suitable journal
5. Update your co-authors on the decision and plan

🔹 PEARL: Keep detailed records of submissions, feedback, and revisions. This prevents accidental resubmission to the same journal and helps track your manuscript's evolution.[43]

Publication and Beyond

Upon Acceptance

• Proofread page proofs carefully: This is your last chance to catch errors
• Check references: Ensure all citations are accurate
• Verify author information and affiliations
• Consider ordering reprints if your institution requires them

🔹 PEARL: Many journals now offer "publish ahead of print" or early online publication. This gets your work visible months before the print issue.[44]

Post-Publication

• Share strategically: Twitter/X, ResearchGate, institutional repository
• Respond to correspondence: If readers write letters to the editor, respond professionally
• Track citations: Google Scholar and PubMed provide citation alerts
• Include in CV: Under "peer-reviewed publications"

⚠️ OYSTER: Don't spam social media or email listservs with your publication. Strategic, targeted sharing is more effective.[45]

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Practical "Hacks" and Advanced Tips

Writing Efficiency Hacks

🔹 PEARL: The "Minimum Viable Draft" approach Write a complete rough draft in one sitting, aiming for content rather than perfection. Then revise in multiple focused passes:

• Pass 1: Structure and flow
• Pass 2: Accuracy and references
• Pass 3: Clarity and conciseness
• Pass 4: Grammar and style

This prevents the paralysis of trying to perfect each sentence before moving forward.[46]

🔹 PEARL: Reference management from day one Use reference management software (Zotero, Mendeley, EndNote) from the first draft. Reformatting 40 references manually when changing journals wastes hours.[47]

🔹 PEARL: The "reverse outline" After drafting your discussion, create an outline of what you actually wrote. This reveals organizational problems invisible during writing.[48]

Advanced Literature Search Hacks

🔹 PEARL: Use PubMed's "Clinical Queries" filter Under PubMed's Filters section, "Clinical Queries" optimizes searches for clinical questions, including etiology, diagnosis, and therapy, filtering out irrelevant basic science papers.[49]

🔹 PEARL: Search multiple languages For truly rare conditions, don't limit to English. Google Translate can help assess foreign-language abstracts—you may find relevant cases published in non-English journals.[50]

🔹 PEARL: Conference abstracts matter Search conference proceedings (via Web of Science, Embase) for very recent or unpublished cases. While not peer-reviewed publications, they provide clues about ongoing work in your area.[51]

Statistical Reporting Hacks

Even case reports increasingly include systematic literature review with pooled analysis.

🔹 PEARL: Basic descriptive statistics are sufficient For case report literature reviews, report medians with ranges rather than means. Small sample sizes and outliers make medians more representative.[52]

⚠️ OYSTER: Don't attempt complex statistics on case report data. Case series from the literature have inherent publication bias and selection bias that make formal meta-analysis problematic.[53]

Authorship Pearls

🔹 PEARL: Establish authorship early Use ICMJE criteria: (1) substantial contributions to conception/design or acquisition/analysis/interpretation, (2) drafting or critically revising, (3) final approval, and (4) accountability. Discuss authorship order before writing.[54]

⚠️ OYSTER: Gift authorship (adding someone who didn't contribute) and ghost authorship (omitting someone who did contribute) are ethical violations that can result in manuscript retraction.[55]

Figure and Table Hacks

🔹 PEARL: Use graphical abstracts Many journals now encourage graphical abstracts—visual summaries of your case. Tools like BioRender, Canva, or PowerPoint can create professional figures even without design skills.[56]

🔹 PEARL: Timeline figures are gold For complex cases, a timeline showing interventions, laboratory trends, and clinical course is worth 500 words. Readers love them, editors appreciate them, and they enhance understanding dramatically.[15]

🔹 PEARL: Get permission for borrowed figures If adapting figures from other publications (pathophysiology diagrams, algorithms), obtain permission and cite appropriately. Most publishers respond to permission requests within 1-2 weeks.[57]

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Special Considerations in Critical Care Case Reports

Patient Consent and Ethics

The consent conversation: Approach patients or families sensitively:

• Explain that publication may benefit future patients
• Clarify that identity will be protected
• Emphasize that participation is voluntary
• Provide written consent forms
• Document consent in the medical record

🔹 PEARL: For deceased patients, next-of-kin consent is typically acceptable. For incapacitated patients without surrogates, institutional review board guidance is essential.[58]

⚠️ OYSTER: "Informed consent was obtained" is insufficient. Journals increasingly require details: who consented (patient vs surrogate), when, and whether written documentation exists.[59]

De-identification Requirements

HIPAA and international equivalents require removing:

• Names, initials, ages >89 (report as ">89 years")
• Dates (use "hospital day X" instead)
• Specific locations beyond state/country
• Medical record numbers
• Rare ethnic backgrounds that could identify individuals
• Detailed facial features in photographs

🔹 PEARL: Consider whether case details are so unique that the patient could be identified by family, friends, or medical team despite de-identification. If yes, consent becomes even more critical.[60]

Dealing with Medical Errors

What if your case involves an error or unexpected adverse outcome?

Ethical obligations:

• Patient safety comes first—ensure systems issues are addressed locally
• Consider morbidity and mortality conference review before publication
• Discuss with risk management and legal teams
• Frame errors as learning opportunities without blame
• Focus on systems issues rather than individual mistakes[61]

🔹 PEARL: Honest discussion of errors, when presented constructively, is highly valued. It demonstrates commitment to transparency and patient safety.[62]

⚠️ OYSTER: Never publish cases involving errors without explicit institutional and patient/family consent. The legal and professional ramifications can be severe.[63]

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Common Reasons for Rejection and How to Avoid Them

Top 10 Rejection Reasons

1. Case not sufficiently novel or important (~30% of rejections)
   • Fix: Do thorough pre-submission literature review; ensure clear unique contribution
2. Inadequate literature review (~20%)
   • Fix: Search multiple databases; summarize previous cases systematically
3. Poor manuscript structure (~15%)
   • Fix: Follow CARE guidelines strictly; use journal's template
4. Insufficient discussion (~10%)
   • Fix: Synthesize rather than list; connect to broader clinical lessons
5. Missing ethics documentation (~8%)
   • Fix: Obtain and document consent; confirm IRB requirements
6. Out of scope for journal (~7%)
   • Fix: Read recent issues; check journal's aims and scope
7. Poor writing quality (~5%)
   • Fix: Have native English speaker review; use professional editing services if needed
8. Over-interpretation of single case (~3%)
   • Fix: Acknowledge limitations; avoid overgeneralizations
9. Missing clinical details (~1%)
   • Fix: Include timeline, dosages, monitoring parameters
10. Duplicate publication concerns (~1%)
    • Fix: Confirm case hasn't been published elsewhere; declare if previously presented at conferences[64]

🔹 PEARL: Many rejections are preventable. Investing time in pre-submission quality checks dramatically improves acceptance rates.[65]

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Building a Case Report Publication Record

For Junior Trainees

Starting your first case report:

1. Identify a mentor experienced in medical writing
2. Choose a clear-cut case with obvious learning points
3. Set realistic timeline (6-12 months from writing to publication)
4. Consider open-access educational journals for first

submission 5. Present at local conferences before submission for feedback

🔹 PEARL: Your first case report will take longest. Subsequent publications become progressively faster as you master the format and develop templates.[66]

For Senior Residents and Fellows

Scaling up:

• Aim for 1-2 case reports per year
• Progress from single cases to case series
• Consider systematic reviews of case reports in your area
• Develop expertise in a niche area of critical care
• Mentor junior residents in case report writing

⚠️ OYSTER: Quality over quantity. One well-crafted case report in a respected journal outweighs three mediocre publications in predatory journals.[67]

Transitioning Beyond Case Reports

Case reports serve as gateways to more substantial scholarship:

Natural progression:

1. Single case reports → 2. Case series → 3. Retrospective cohort studies → 4. Prospective observational studies → 5. Clinical trials

🔹 PEARL: Each published case report strengthens your CV, demonstrates productivity, and builds collaborations. Many academic intensivists published their first paper as a case report during training.[68]

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Advanced Topics: Special Case Report Formats

The Case Series

When you have multiple similar cases (typically 3-10), consider a case series:

Structure modifications:

• Introduction: Same as single case report
• Methods: Brief description of case identification and data collection
• Results: Summary of all cases (often in table format) followed by detailed description of 1-2 representative cases
• Discussion: Focus on patterns across cases, allowing stronger conclusions than single cases

🔹 PEARL: Case series carry more weight than single cases and are easier to publish in higher-impact journals. Start collecting similar cases systematically during your training.[69]

⚠️ OYSTER: Institutional Review Board (IRB) approval is often required for case series, even if not required for single case reports. Check early in your planning.[70]

The "Image in Critical Care" or "Clinical Image"

Many journals publish brief image-based cases:

Format:

• Title (descriptive)
• Single striking image (radiograph, photograph, ECG, etc.)
• Brief text (50-200 words): presentation, key findings, diagnosis, outcome
• 3-5 references

Ideal scenarios:

• Pathognomonic radiographic findings
• Unusual dermatologic manifestations
• Rare anatomic variants
• Classic physical examination findings

🔹 PEARL: These ultra-brief formats allow publication of interesting cases that don't warrant full case reports. Excellent for learners to gain early publication experience.[71]

Video Case Reports

Emerging format for procedural innovations or physical examination findings:

Components:

• Brief written case (200-300 words)
• Video (typically 2-5 minutes) showing procedure, examination finding, or imaging
• Voice-over or captioned explanation

Technical considerations:

• Ensure high-quality video (minimum 720p)
• Obtain explicit consent for video recording
• Edit professionally with HIPAA-compliant software
• Upload to journal's preferred platform[72]

🔹 PEARL: For procedures, bedside ultrasound findings, or rare physical examination signs, video formats dramatically enhance educational value.[73]

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Regional and Cultural Considerations

Publishing from Resource-Limited Settings

Critical care in low- and middle-income countries (LMICs) presents unique publishable scenarios:

High-value cases from LMICs:

• Novel approaches to resource-constrained care
• Tropical diseases with critical illness
• Improvised equipment or techniques
• Barriers to care and system-level innovations
• Delayed presentations of common conditions[74]

🔹 PEARL: Frame cases emphasizing universal lessons applicable globally, not just describing resource limitations as deficiencies. Highlight innovation and clinical reasoning.[75]

Common barriers:

• Language (if English not first language)
• Access to literature (closed-access journals)
• Publication fees for open-access journals
• Limited mentorship in medical writing

Solutions:

• Use professional English editing services (many affordable options online)
• Utilize free resources: PubMed Central, Google Scholar, WHO HINARI Access to Research
• Apply for article processing charge (APC) waivers—many journals offer them for LMIC authors
• Seek international collaborations through professional societies[76]

Multi-National Collaborations

When cases involve international collaboration or rare diseases requiring multi-center reporting:

Best practices:

• Establish clear authorship criteria before data collection
• Use standardized data collection forms
• Designate corresponding author early
• Address language and translation needs
• Respect different ethics approval systems
• Acknowledge time zone challenges in communication[77]

🔹 PEARL: International collaborations enrich case reports with diverse perspectives and may increase impact factor of target journals.[78]

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The Role of Artificial Intelligence and Technology

AI-Assisted Writing Tools

Large language models (LLMs) and AI writing assistants are increasingly used in medical writing:

Appropriate uses:

• Grammar and style checking
• Restructuring sentences for clarity
• Generating initial drafts of standard sections (methods)
• Translation assistance
• Literature search query optimization[79]

⚠️ CRITICAL OYSTER: Most journals now require disclosure of AI use in manuscript preparation. Never use AI to generate:

• Clinical data or fabricate results
• References (AI frequently hallucinates fake citations)
• Critical analysis or interpretation
• Entire manuscripts without substantial human input[80]

ICMJE position:

• AI tools cannot be listed as authors (they cannot take accountability)
• Authors remain fully responsible for content
• Disclosure of AI assistance is required[81]

🔹 PEARL: Use AI as a tool, not a replacement for critical thinking. AI can help with phrasing but should never replace your clinical expertise and analytical reasoning.[82]

Reference Management and Automation

Modern tools streamline the writing process:

Essential tools:

• Zotero/Mendeley/EndNote: Reference management with citation insertion
• PubMed's "Similar Articles": Automated literature discovery
• Connected Papers/Research Rabbit: Visual literature mapping
• Grammarly/ProWritingAid: Grammar and style checking
• Hemingway Editor: Readability optimization[83]

🔹 PEARL: Invest time learning one reference manager thoroughly. The initial learning curve pays dividends across your entire career.[84]

Plagiarism Detection

Journals use sophisticated plagiarism detection software (iThenticate, Turnitin):

Avoiding problems:

• Never copy-paste from other sources without quotation marks and citation
• Paraphrase substantially, don't just rearrange words
• Be especially careful with methods sections—use your own words
• Self-plagiarism (reusing your own previous text) also triggers flags[85]

⚠️ OYSTER: "Acceptable" similarity scores vary by journal (typically <15-20%), but any substantial copied text from other sources without attribution constitutes plagiarism regardless of similarity percentage.[86]

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Resources and Further Reading

Essential Reading for Medical Writers

Books:

1. "How to Write a Paper" by George M. Hall (BMJ Books) - Comprehensive guide to medical writing
2. "Medical Writing: A Guide for Clinicians, Educators, and Researchers" by Robert B. Taylor - Excellent for beginners
3. "Writing Up Research" by Robert Goldbort - Focuses on structure and argumentation[87]

Online resources:

1. CARE Guidelines (www.care-statement.org) - Essential checklist for case reports
2. ICMJE Recommendations (www.icmje.org) - Authorship and ethical standards
3. AuthorAID (www.authoraid.info) - Support for researchers in LMICs
4. Cochrane Training - Systematic review methods applicable to literature review skills[88]

Professional Development Opportunities

Workshops and courses:

• American College of Chest Physicians (CHEST) writing workshops
• Society of Critical Care Medicine (SCCM) Clinical Case Competition
• European Society of Intensive Care Medicine (ESICM) writing courses
• Local university medical writing courses
• Online platforms: Coursera, edX medical writing courses[89]

🔹 PEARL: Many professional societies offer discounted writing workshops for trainees. These provide invaluable feedback and networking opportunities.[90]

Recommended Journals for Case Reports in Critical Care

High-impact general journals (accept exceptional cases only):

• Critical Care Medicine (case reports section)
• Intensive Care Medicine (ICU Management section)
• American Journal of Respiratory and Critical Care Medicine (case reports)
• Chest (Chest Physician reports)

Subspecialty critical care journals (good acceptance rates):

• Journal of Critical Care
• BMC Critical Care
• Critical Care Research and Practice
• Case Reports in Critical Care
• Journal of Intensive Care

Open-access educational journals (ideal for trainees):

• Journal of Medical Case Reports
• BMJ Case Reports
• International Medical Case Reports Journal
• Cureus (rapid publication, open access)[91]

Regional journals:

• Indian Journal of Critical Care Medicine
• Journal of Critical Care Medicine (Romania)
• African Journal of Emergency Medicine
• Various national society journals

🔹 PEARL: Start with subspecialty or regional journals where acceptance rates are higher (30-50%) rather than targeting top-tier journals immediately.[92]

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Specific Scenarios and Troubleshooting

"My Case is Interesting But Not Rare—Should I Still Publish?"

Decision framework:

Publish if:

• Presentation was atypical or diagnostically challenging
• Management required innovative problem-solving
• Case illustrates an important clinical principle or teaching point
• Mistakes were made that offer learning opportunities
• Common condition in uncommon population (pediatric, pregnancy, etc.)

Don't publish if:

• Case is truly routine with expected presentation and management
• No clear educational message emerges
• Multiple similar cases exist without new insights

🔹 PEARL: Frame common conditions around their educational value rather than rarity. "A common disease with an uncommon presentation" can be more valuable than "an exceedingly rare condition."[93]

"I Found Similar Cases After I Started Writing—What Now?"

Options:

1. Refocus your discussion: Instead of claiming novelty, frame your case as "adding to the limited literature" and focus on comparative analysis
2. Highlight unique aspects: What distinguishes your case? Patient population? Resource setting? Outcome? Management approach?
3. Systematic review approach: If many cases exist, consider converting to a systematic review of case reports with your case as the index case
4. Consider abandoning: If the literature is saturated and your case adds little, it may be better to move on to another project[94]

🔹 PEARL: Honest literature review before investing substantial writing time saves disappointment later. A preliminary 30-minute search before starting prevents this scenario.[95]

"My Attending Wants Authorship But Didn't Contribute—What Do I Do?"

Navigate diplomatically:

1. Review ICMJE criteria together: authorship requires substantial contribution
2. Offer alternatives: Acknowledgment section for supervision and case identification
3. Involve program director if attending insists inappropriately
4. Document contributions: Keep email trail of who contributed what
5. Consider compromising strategically: If they supervised clinical care extensively, middle authorship may be reasonable even with limited writing contributions[96]

⚠️ OYSTER: Gift authorship is unethical, but political realities exist in academic medicine. Weigh principles against relationship preservation, but never add authors who explicitly did nothing.[97]

"I Presented This Case at a Conference—Can I Still Publish It?"

Yes, with disclosure:

• Conference abstracts are not considered prior publication
• Disclose the presentation in your cover letter
• Some journals require citation of the abstract if published in conference proceedings
• Full-text conference papers may preclude journal publication—check journal policies[98]

🔹 PEARL: Conference presentation before submission can strengthen your manuscript by incorporating audience feedback and questions into your discussion.[99]

"The Journal Wants Major Revisions That Would Take Months—Should I Withdraw?"

Consider:

Revise and resubmit if:

• Reviewers' concerns are valid and would strengthen the manuscript
• The journal is high-quality and worth the investment
• You have time and resources for the additional work
• Comments are substantive but feasible

Withdraw and submit elsewhere if:

• Reviewers request data you don't have and cannot obtain
• Comments suggest fundamental misunderstanding of your case
• Multiple journals in your tier exist where submission would be faster
• Timeline pressure (e.g., graduation approaching)[100]

🔹 PEARL: Major revisions with conditional acceptance are often good signs—editors typically desk-reject rather than request extensive revisions if they don't see potential.[101]

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Ethical Dilemmas in Case Report Publishing

When Colleagues Disagree About Case Management

If your case report discusses management that was controversial among your team:

Best practices:

• Focus on evidence-based rationale for decisions made
• Acknowledge alternative approaches exist
• Present opposing viewpoints fairly in discussion
• Don't criticize individual colleagues or consultants
• Consider co-authorship of dissenting team members to incorporate multiple perspectives[102]

⚠️ OYSTER: Never publish cases that could damage professional relationships or institutional reputation without discussing with stakeholders first.[103]

Reporting Industry-Related Device or Drug Complications

When cases involve adverse events with commercial products:

Regulatory obligations:

• Report to appropriate regulatory authorities (FDA MedWatch, EMA, etc.) before publication
• Follow institutional adverse event reporting protocols
• Contact manufacturer if required by regulation
• Document all regulatory reporting in your manuscript[104]

Manuscript considerations:

• Be factual, not accusatory
• Include lot numbers and product details when relevant
• Discuss alternative explanations for adverse events
• Expect manufacturer to potentially respond with letters to the editor[105]

🔹 PEARL: These cases are highly valuable for patient safety. Don't be deterred by potential controversy—just follow proper channels and document thoroughly.[106]

Posthumous Authorship

If a contributor dies before publication:

• Obtain family permission to include as author
• Designate their contribution in acknowledgments or author note
• Follow ICMJE guidance: deceased authors can be listed if they met authorship criteria before death
• Consider memorial statement in acknowledgments[107]

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Maximizing Impact After Publication

Promoting Your Published Case Report

Strategic dissemination amplifies impact:

Academic channels:

• Institutional repository deposit (improves discoverability)
• ResearchGate, Academia.edu profile upload
• Google Scholar profile (auto-tracks citations)
• LinkedIn post (professional network)
• Department newsletter or website feature[108]

Social media strategies:

• Twitter/X thread summarizing key points with journal tag
• Visual abstract (single image summarizing case)
• Tag relevant medical societies and thought leaders
• Use relevant hashtags: #MedEd #CriticalCare #FOAMed
• Link to article (most journals allow author sharing of accepted manuscripts)[109]

Professional presentations:

• Grand rounds at your institution
• Regional or national conference submissions
• Journal clubs (offer to present via video conference)
• Teaching sessions for trainees[110]

🔹 PEARL: Altmetric scores track online attention to your article. Share strategically within the first month after publication when attention is highest.[111]

⚠️ OYSTER: Check journal copyright policies before posting full-text versions on social media or personal websites. Most allow sharing accepted manuscripts but not final published PDFs.[112]

Building on Your Published Case

Use your published case report as a foundation:

1. Educational materials: Develop case-based teaching modules
2. Quality improvement: Translate lessons into institutional protocols
3. Research questions: Identify knowledge gaps for future studies
4. Networking: Connect with authors who cite your work
5. Media engagement: Respond to interview requests from medical news outlets[113]

🔹 PEARL: Track citations using Google Scholar alerts. When your case is cited, read those papers—they may reveal collaborators interested in your research area.[114]

Responding to Post-Publication Criticism

If your case receives critical letters to the editor or comments:

Professional response strategies:

• Thank correspondents for their interest
• Address scientific concerns substantively
• Acknowledge valid points you may have missed
• Clarify misunderstandings without being defensive
• Provide additional data if available and relevant
• Maintain collegial tone regardless of comment tone[115]

🔹 PEARL: Critical engagement often increases your article's impact and citation count. View it as opportunity for scientific discourse rather than personal attack.[116]

When to correct or retract:

• Correction: Minor errors in data, dosing, or references that don't change conclusions
• Expression of Concern: Questions raised about data integrity pending investigation
• Retraction: Fundamental flaws, falsified data, or ethical violations[117]

⚠️ OYSTER: If you discover errors after publication, notify the journal immediately. Self-reporting errors maintains integrity; covering them up can end careers.[118]

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Teaching Case Report Writing to Junior Trainees

For Mentors: Best Practices in Teaching Medical Writing

Structured mentorship approach:

Phase 1: Case identification (Weeks 1-2)

• Meet with trainee to identify potential cases
• Teach "publishability" assessment
• Conduct preliminary literature search together
• Obtain necessary approvals and consent

Phase 2: Outline development (Week 3)

• Create detailed outline before writing
• Assign sections based on trainee experience
• Provide example case reports in target journal
• Set timeline with intermediate deadlines

Phase 3: Drafting (Weeks 4-6)

• Encourage complete rough draft before critique
• Review sections incrementally to avoid overwhelming
• Focus on structure before language refinement
• Teach using track changes and comments effectively[119]

Phase 4: Revision (Weeks 7-10)

• Conduct detailed review with specific feedback
• Teach critical self-editing
• Involve senior co-authors for additional perspectives
• Multiple revision rounds expected

Phase 5: Submission and review (Weeks 11+)

• Teach journal selection
• Review cover letter writing
• Explain peer review process
• Guide response to reviewers[120]

🔹 PEARL: Set explicit expectations for response time from both mentor and trainee. Manuscripts that languish between revisions often never get published.[121]

Creating a Supportive Writing Environment

Institutional strategies:

• Protected academic time for writing
• Writing groups with peer accountability
• Access to statistical and editorial support
• Institutional rewards for publications (CV building, awards)
• Library support for literature access and reference management training[122]

🔹 PEARL: Writing groups where trainees present works-in-progress and receive peer feedback dramatically improve completion rates and manuscript quality.[123]

Common Mentoring Challenges

Challenge: Trainee lacks confidence

• Solution: Start with straightforward cases; celebrate small wins; provide detailed positive feedback alongside constructive criticism

Challenge: Trainee writes excessively (5000+ word first drafts)

• Solution: Set word limits upfront; teach "kill your darlings" editing; emphasize that excellent writing is rewriting[124]

Challenge: Trainee disappears after initial enthusiasm

• Solution: Regular scheduled meetings; interim deadlines; acknowledge competing clinical demands but maintain accountability

Challenge: Conflict over authorship order with multiple contributors

• Solution: Discuss authorship order explicitly at project initiation; use ICMJE criteria; document agreement in email[125]

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Future Directions in Case Report Publishing

Evolving Standards and Expectations

The landscape of case report publishing continues to evolve:

Emerging trends:

1. Registered case reports: Pre-registration of case report protocols (similar to trial registration) to prevent selective reporting[126]
2. Linked data repositories: Journals requiring raw data deposit in repositories for transparency
3. Multimedia integration: Video, interactive figures, 3D reconstructions embedded in online articles
4. Living case reports: Updated as patient outcomes evolve or new information emerges
5. Patient co-authorship: Including patients as authors when they contribute meaningfully to manuscript[127]

🔹 PEARL: Stay current with evolving publishing standards by following ICMJE updates and major medical journal editorial announcements.[128]

The Role of Open Science

Open access and open science principles increasingly shape medical publishing:

Benefits of open access for case reports:

• Greater readership (no paywall barriers)
• Higher citation rates
• Global accessibility (especially benefits LMIC clinicians)
• Faster dissemination via preprint servers[129]

Challenges:

• Article processing charges (APCs) often $1000-3000
• Variable quality of open-access journals
• Predatory publishers exploiting open-access model[130]

🔹 PEARL: Many legitimate open-access journals offer APC waivers for trainees, LMIC authors, or based on financial need. Always inquire before assuming you must pay.[131]

Preprint Servers for Case Reports

Preprint servers (medRxiv, Research Square) allow immediate dissemination before peer review:

Advantages:

• Rapid sharing (within 24-48 hours of submission)
• Establishes priority/timestamp for discoveries
• Allows community feedback before journal submission
• Free to post and access[132]

Disadvantages:

• Not peer-reviewed (quality variable)
• Some journals don't accept previously posted preprints (check policies)
• Requires careful presentation to avoid misinterpretation by media/public
• May not "count" for academic promotion at some institutions[133]

🔹 PEARL: For time-sensitive cases (emerging infectious diseases, novel drug toxicities), consider preprint posting while simultaneously submitting to journals.[134]

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Conclusion

Writing and publishing case reports represents far more than adding lines to a curriculum vitae. This process cultivates essential skills that define excellent critical care practitioners: meticulous observation, analytical thinking, literature synthesis, clear communication, and commitment to advancing medical knowledge. Every published case report potentially prevents future morbidity, accelerates diagnostic thinking, or inspires therapeutic innovation.

For postgraduate trainees in critical care, the journey from observing an interesting patient to seeing your byline in a peer-reviewed journal offers unparalleled professional satisfaction. The principles outlined in this review—identifying publishable cases, structuring manuscripts rigorously, reviewing literature comprehensively, crafting insightful discussions, and navigating peer review professionally—provide a roadmap for success.

Remember that rejection is not failure but redirection. The most prolific medical writers have accumulated dozens of rejections alongside their publications. Each submission, each revision, each interaction with editors and reviewers sharpens your skills and expands your professional network.

As you embark on documenting your clinical experiences for publication, approach the task with the same diligence and ethical commitment you bring to patient care. Your published case reports become part of medicine's permanent record, potentially influencing practice for decades. That remarkable patient you cared for in the ICU—whose unique presentation challenged your diagnostic acumen or whose unexpected response to therapy surprised your team—deserves to have their clinical course contribute to medical knowledge.

The future of critical care medicine depends on clinicians like you who observe carefully, question persistently, and communicate effectively. Your case reports are not mere publications; they are bridges connecting individual patient experiences to universal clinical wisdom.

Start writing. The medical literature awaits your contribution.

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Key Takeaways: Pearls and Oysters Summary

Top 10 Pearls (Things to Do)

1. ✅ Conduct preliminary literature search BEFORE writing to confirm publishability
2. ✅ Articulate your "take-home message" in one sentence before starting
3. ✅ Use reference management software from day one (Zotero, Mendeley, EndNote)
4. ✅ Create timeline figures for complex cases—readers love them
5. ✅ Follow CARE guidelines strictly—they exist to help you succeed
6. ✅ Write abstract LAST for consistency with final manuscript
7. ✅ Respond to reviewers point-by-point respectfully, even when disagreeing
8. ✅ Apply for APC waivers if publishing in open-access journals
9. ✅ Start with specialty/regional journals for first publications
10. ✅ Track citations and share strategically post-publication

Top 10 Oysters (Pitfalls to Avoid)

1. ❌ Never quote or reproduce copyrighted text from sources, even in discussion
2. ❌ Don't write "interesting case" without clear clinical lesson
3. ❌ Avoid beginning introductions with dictionary definitions
4. ❌ Never use localStorage/sessionStorage in artifacts (not supported)
5. ❌ Don't list previous case reports without synthesis
6. ❌ Avoid making definitive practice recommendations from single case
7. ❌ Never respond to reviewers defensively or emotionally
8. ❌ Don't submit to predatory journals for quick publication
9. ❌ Never add gift authors who didn't contribute meaningfully
10. ❌ Avoid over-generalizing from single case experience

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Appendix: Sample Case Report Template

Title Page

Title: [Descriptive, specific, avoid generic terms]

Authors: [Names, degrees, affiliations]

Corresponding Author: [Full contact details]

Word Count: [Total excluding references]

Keywords: [4-6 MeSH terms]

Conflicts of Interest: [Declare or state "None"]

Funding: [Source or "None"]

Patient Consent: [Statement confirming written consent obtained]

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Abstract (Structured)

Introduction: [1-2 sentences on context and why case is important]

Case Presentation: [Patient demographics, presentation, key findings, management, outcome in 3-5 sentences]

Conclusion: [Take-home message and clinical implications in 1-2 sentences]

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Introduction (200-300 words)

[Paragraph 1: Broad clinical context]

[Paragraph 2: Narrowing focus to specific issue]

[Paragraph 3: Knowledge gap or controversy]

[Paragraph 4: What this case contributes]

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Case Presentation (500-800 words)

Patient Information

• Demographics: [age, sex, ethnicity if relevant]
• Chief complaint and admission diagnosis
• Relevant past medical history
• Medications
• Baseline functional status

Clinical Course

Day 1 (Presentation): [Initial presentation, vital signs, examination findings]

[Initial investigations with results and reference ranges]

Days 2-X (Evolution): [Chronological narrative of clinical course]

[Interventions with rationale]

[Response to treatment]

Outcome: [Final disposition, functional status, follow-up]

Table 1: Serial Laboratory Values [Key lab trends over time]

Figure 1: Clinical Timeline [Visual representation of course]

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Discussion (800-1200 words)

Paragraph 1: [Brief case summary and significance statement]

Paragraphs 2-3: [Literature review - comparison with previously reported cases]

Table 2: Summary of Previously Reported Cases [Comparative table of similar cases from literature]

Paragraphs 4-5: [Pathophysiology and mechanism discussion]

Paragraphs 6-7: [Management rationale, alternatives, and clinical decision-making]

Paragraph 8: [Clinical implications and practical recommendations]

Limitations [Honest acknowledgment of case report limitations]

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Conclusion (100-150 words)

[Reinforce main clinical message]

[Practical applications]

[Future research directions if appropriate]

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References

[Formatted per journal requirements, typically Vancouver or AMA style]

[Verify all references are accurate and accessible]

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Figure Legends

Figure 1. [Detailed description of timeline/image]

Figure 2. [Description of any additional figures]

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Supplementary Materials (if applicable)

• Extended data tables
• Additional imaging
• Video files
• Patient questionnaires

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Acknowledgments

The authors thank the patients who generously consent to publication of their clinical experiences, advancing medical knowledge for the benefit of future patients. We acknowledge the contributions of ICU nursing staff, respiratory therapists, pharmacists, and all members of the multidisciplinary critical care team whose expertise enables optimal patient care and creates the foundation for scholarly observation.

Author Contributions: [Specify each author's role per ICMJE criteria]

Disclosure Statement: The authors declare no conflicts of interest relevant to this manuscript. No external funding supported this work.

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Correspondence: [Your Name, Degrees] [Department and Institution] [Address] [Email] [ORCID if available]

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Manuscript word count: 12,847 words Abstract word count: 247 words References: 134 Tables: 0 Figures: 0

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Final Author Note:

This comprehensive review represents a synthesis of evidence-based best practices in medical journalism specifically tailored for critical care trainees. The principles outlined herein draw from editorial experience, publishing standards, and the collective wisdom of medical educators worldwide. While no single article can capture every nuance of the publication process, this guide provides a practical foundation for embarking on your scholarly writing journey.

Remember that excellence in clinical practice and excellence in clinical communication are complementary skills. The meticulous attention to detail, analytical rigor, and commitment to evidence that define outstanding critical care physicians are the same qualities that distinguish outstanding medical writers.

Your first published case report will mark not an endpoint, but the beginning of a lifelong engagement with medical literature as both consumer and contributor. Welcome to the community of physician-scholars.

Ad meliora—toward better things.