The Principles of Medical Journalism: How to Write and Review a Case Report
A Practical Guide for Critical Care Practitioners
Dr Neeraj Manikath , Claude.ai
Abstract
Case reports remain a cornerstone of medical literature, bridging clinical observation with scientific discourse. Despite their apparent simplicity, crafting a publishable case report requires mastery of narrative medicine, critical appraisal skills, and an understanding of editorial expectations. This review article provides critical care practitioners with a structured approach to conceptualizing, writing, and reviewing case reports. We explore the criteria that distinguish publishable cases, dissect the anatomical structure of exemplary reports, and provide practical strategies for literature synthesis and manuscript preparation. Additionally, we navigate the often-opaque peer-review process, offering insights from both author and reviewer perspectives. By integrating "pearls" of wisdom and "oysters" of common pitfalls, this guide aims to elevate the quality of case-based scholarship in critical care medicine.
Keywords: Case report, medical writing, peer review, critical care, medical journalism, literature review
Introduction
The case report occupies a unique niche in the hierarchy of medical evidence. While randomized controlled trials command the apex of evidence-based medicine, case reports serve as the sentinels of clinical discovery—often the first signal of novel disease presentations, unexpected adverse effects, or innovative therapeutic approaches.1,2 In critical care, where patients frequently present with multi-organ dysfunction and atypical manifestations, the case report becomes particularly valuable for disseminating clinical wisdom that may never be captured in large trials.3
Yet, the rejection rate for case reports remains notably high, often exceeding 70% in leading journals.4 The paradox is striking: while every clinician encounters "interesting cases," few translate into meaningful scholarly contributions. The distinction lies not merely in the case itself, but in the author's ability to extract generalizable knowledge from a singular clinical encounter.
Pearl: Think of a case report not as a story about a patient, but as a teaching tool dressed in narrative clothing.
This article provides a systematic framework for transforming clinical observations into publishable scholarship, with particular emphasis on the nuances relevant to critical care practice.
What Makes a Case "Publishable"? Rarity, Educational Value, and a Clear Message
The Trinity of Publishability
Not every unusual case warrants publication. Editors evaluate submissions through three fundamental lenses: rarity, educational value, and message clarity.<sup>5,6</sup>
1. Rarity: The Spectrum of Novelty
Rarity exists on a spectrum:
Absolute novelty represents the first reported case of a condition, presentation, or therapeutic approach. Examples include the first description of a new disease entity or the first use of extracorporeal membrane oxygenation (ECMO) in a previously unconsidered indication.7
Relative rarity encompasses unusual presentations of known conditions. A case of COVID-19-associated mucormycosis in a non-diabetic patient, while not the first such case, may still merit publication if it challenges existing paradigms or occurs in an underrepresented population.8
Oyster: Rarity alone is insufficient. The medical literature is replete with rejected "zebra cases" that offered no learning beyond their oddity. Unusual must meet useful.
2. Educational Value: The "So What?" Test
Every case report must answer the critical question: "What will readers do differently after reading this?"<sup>9</sup> Educational value manifests in several forms:
- Diagnostic insights: Cases that illustrate pathognomonic findings, describe novel diagnostic approaches, or highlight diagnostic pitfalls
- Therapeutic lessons: Reports of successful management of challenging conditions, innovative treatment protocols, or important adverse effects
- Prognostic information: Cases that enhance understanding of disease trajectory or outcomes
- Healthcare delivery insights: Reports addressing system-level issues, ethical dilemmas, or quality improvement10
Pearl: The best case reports change clinical practice. Ask yourself: "If a colleague read this at 2 AM in the ICU, would it help them make a better decision?"
3. Message Clarity: The Singular Focus
A publishable case report conveys one clear, memorable message.<sup>11 Attempting to extract multiple lessons from a single case typically dilutes impact and confuses readers.
Good title: "Dexmedetomidine-Induced Bradycardia Leading to Cardiac Arrest: A Cautionary Tale"
Poor title: "A Complex ICU Case with Multiple Complications"
The difference is specificity. The first promises a focused lesson; the second promises confusion.
Assessing Your Case: A Practical Checklist
Before investing time in writing, evaluate your case using the RARE criteria:
- Relevance to current clinical practice
- Addition to existing literature (fills a gap)
- Reproducible lesson (others can apply the insight)
- Evidence-based discussion (not just anecdote)
Hack: Perform a rapid PubMed search before committing to writing. If you find >10 similar cases published in the last 3 years, consider whether your case truly adds something new. If yes, articulate that difference explicitly.
The STRUCTURE of a Case Report: Abstract, Introduction, Case, Discussion, Conclusion
The IMRAD Framework Adapted
While research articles follow the IMRAD structure (Introduction, Methods, Results, And Discussion), case reports adapt this to: Abstract, Introduction, Case Presentation, Discussion, and Conclusion.12 Each component serves a distinct purpose.
1. The Abstract: Your 30-Second Pitch
The abstract determines whether editors and readers proceed beyond the first page. Most journals require structured abstracts of 150-250 words containing:
- Background: One sentence contextualizing the case
- Case presentation: Concise summary of key clinical features
- Conclusion: The take-home message
Pearl: Write your abstract last, but read it first. It crystallizes your thinking and ensures your entire manuscript delivers on its promise.
Example of a strong abstract opening:
"Propofol-related infusion syndrome (PRIS) is a rare but potentially fatal complication of prolonged propofol sedation. We report a case of PRIS in a 34-year-old trauma patient that presented atypically with isolated renal failure without the characteristic metabolic acidosis..."
2. Introduction: Setting the Stage (200-300 words)
The introduction should:
- Define the condition or context
- Establish its clinical significance
- State why this case merits reporting
- Provide a brief literature context
Oyster: Avoid exhaustive literature reviews in the introduction. One or two key references suffice. Save the comprehensive review for the discussion.
Structure for critical care case reports:
Paragraph 1: Define the condition and its importance
Paragraph 2: State what's unknown, controversial, or challenging
Paragraph 3: Preview why this case addresses that gap
3. Case Presentation: Painting the Clinical Picture (400-600 words)
This section follows a chronological narrative but requires judicious editing. Not every laboratory value or clinical detail belongs in print.
Essential components:
- Patient demographics: Age, sex, relevant comorbidities (de-identified)
- Presentation: Chief complaint, symptoms, examination findings
- Investigations: Relevant laboratory, imaging, and diagnostic test results
- Management: Interventions, therapeutic decisions, and rationale
- Outcome: Clinical course and disposition
Pearl: Use Tables and Figures strategically. A well-designed table showing laboratory trends is more impactful than three paragraphs of text.
Hack for critical care cases: Organize complex ICU cases using a systems-based approach or timeline rather than pure chronology. Consider:
- Day 1-3: Initial presentation and resuscitation
- Day 4-7: Complications and management adjustments
- Day 8-14: Recovery or escalation
Example of effective case presentation style:
"A 42-year-old woman with no significant medical history presented to the emergency department with fever (39.2°C), headache, and confusion of 24-hour duration. Initial Glasgow Coma Scale was 13 (E3V4M6). Cerebrospinal fluid analysis revealed 450 white blood cells/μL (85% neutrophils), protein 1.2 g/L, and glucose 2.1 mmol/L (serum glucose 6.2 mmol/L), consistent with bacterial meningitis..."
Oyster: Do not include informed consent statements in the manuscript body. These belong in the cover letter or methods section, per journal requirements.
4. Discussion: Where Cases Become Scholarship (600-800 words)
The discussion transforms narrative into education. This is where you demonstrate expertise and situate your case within the broader medical context.
Recommended structure:
Paragraph 1: Restate the key finding Begin with a clear statement of your main message.
"This case illustrates that PRIS can present without metabolic acidosis when diagnosed early, challenging the classical diagnostic criteria."
Paragraphs 2-3: Compare with existing literature Systematically review similar cases (typically 3-8 most relevant reports), highlighting similarities and differences with your case.
Paragraphs 4-5: Pathophysiological or mechanistic insights Explain the "why" behind the observation. In critical care, this often involves discussing:
- Pharmacological mechanisms
- Pathophysiological cascades
- Organ system interactions
Paragraph 6: Clinical implications Translate the case into actionable insights for practicing clinicians.
Paragraph 7: Limitations Acknowledge what cannot be concluded from a single case.
Pearl: The discussion is not a general review of the condition. Every sentence should connect back to YOUR case. Use phrases like "In our patient..." or "Unlike our case..." to maintain focus.
5. Conclusion: The Memorable Exit (100-150 words)
The conclusion should:
- Restate the main lesson succinctly
- Avoid introducing new information
- End with a forward-looking statement or call to action
Effective conclusion example:
"This case demonstrates that eosinophilic myocarditis can mimic acute coronary syndrome in critically ill patients. Clinicians should maintain a high index of suspicion when troponin elevation occurs without coronary disease, particularly in the presence of peripheral eosinophilia. Early endomyocardial biopsy can confirm the diagnosis and guide immunosuppressive therapy, potentially preventing progression to cardiogenic shock."
Oyster: Never write "More research is needed" without specifying what kind of research and why. This phrase has become meaningless through overuse.
Performing a Lit Review: Finding the Relevant "Previously Reported Cases"
The Art and Science of Case Literature Synthesis
A comprehensive yet focused literature review distinguishes excellent case reports from mediocre ones. In the era of information overload, the challenge is not finding literature but finding the right literature.13
Search Strategy: Beyond Basic PubMed
Step 1: Define your search question Use the PICO framework adapted for case reports:
- Patient/Problem: Your patient's key characteristics
- Intervention/Index test: What you did or found
- Comparator: Alternative approaches (if applicable)
- Outcome: What happened
Step 2: Systematic database searching
PubMed/MEDLINE:
- Use MeSH terms combined with text words
- Apply filters: "Case Reports" publication type
- Use the "Similar articles" function for seminal cases
Example search strategy for ECMO in COVID-19 ARDS:
("COVID-19"[MeSH] OR "SARS-CoV-2"[MeSH]) AND
("Extracorporeal Membrane Oxygenation"[MeSH] OR "ECMO"[tiab]) AND
("Case Reports"[Publication Type] OR "case report"[tiab])
Pearl: Don't limit to English-only papers initially. Important cases may be reported first in regional journals. Use translation tools for abstracts.
Additional databases for comprehensive searching:
- Embase: Particularly strong for European literature
- Scopus: Broad coverage including conference abstracts
- Google Scholar: Catches grey literature but requires careful vetting
- ClinicalTrials.gov: For ongoing or completed trials that may contextualize your case
Step 3: Reference mining
- Review references of key articles (backward citation searching)
- Use "cited by" functions to find newer relevant papers (forward citation searching)
- Check the journals that frequently publish cases in your specialty
Hack: Create a spreadsheet to track cases as you review literature. Columns should include: Author, Year, Patient characteristics, Intervention/Finding, Outcome, and "How it relates to my case." This becomes invaluable when writing your discussion.
Critical Appraisal of Case Literature
Not all published cases are equally credible. Evaluate each report for:
- Diagnostic certainty: Was the diagnosis confirmed or presumed?
- Completeness: Are key details provided or omitted?
- Bias: Is the report from the manufacturer of a device/drug being promoted?
- Quality: Does it follow reporting guidelines (CARE checklist)?14
Oyster: Resist the temptation to cite every remotely related case. Quality trumps quantity. Ten carefully selected and analyzed cases beat thirty mentioned in passing.
Organizing Your Literature Review
For the discussion section, organize cases thematically rather than chronologically:
Option 1: Tabular summary Create a table comparing key features of your case with previously reported cases. This is particularly effective when multiple cases exist.
Example:
| Author, Year | Age/Sex | Presentation | Treatment | Outcome |
|---|---|---|---|---|
| Smith, 2020 | 45/M | Fever, rash | Steroids | Survived |
| Your case | 42/F | Fever, confusion | Steroids + IVIG | Survived |
Option 2: Narrative synthesis When cases are heterogeneous, group them by outcome, intervention, or key feature.
Pearl: If >20 cases exist, consider a systematic approach. State your search strategy explicitly: "A PubMed search from 2000-2024 using the terms... yielded 24 relevant cases. We identified three patterns..."
The Literature Gap: Your Case's Justification
Your literature review should explicitly identify what gap your case fills:
- First case in a specific population (pediatric, geriatric, pregnancy)
- First case with a particular comorbidity
- First case using a specific intervention
- Largest series or longest follow-up
- Case that challenges prevailing dogma
Hack: Include a "literature synthesis statement" in your discussion: "Review of 18 previously reported cases reveals that all patients with [condition] and [characteristic] had [outcome], except in cases where [intervention] was used early. Our case supports this observation and extends it to..."
The Discussion Section: Moving from Your Case to the Broader Clinical Lesson
Elevating Narrative to Scholarship
The discussion section separates acceptable case reports from exceptional ones. This is where you demonstrate clinical reasoning, synthesize evidence, and provide actionable insights.15
The "Hourglass" Discussion Structure
Think of the discussion as an hourglass:16
Wide (Opening): Begin with the big picture—why this case matters to the broader field
Narrow (Middle): Focus tightly on the specific findings of your case and similar cases
Wide (Closing): Expand again to clinical implications, future directions, and take-home messages
Six Essential Elements of a Strong Discussion
1. Statement of Principal Findings
Open with a clear, definitive statement of what your case demonstrates. Avoid hedging in the first sentence.
Weak: "Our case suggests that perhaps in some situations, drug X might be considered..."
Strong: "This case demonstrates that drug X successfully reversed refractory vasodilatory shock when conventional vasopressors failed."
2. Contextualization Within Existing Literature
Compare and contrast your case with previously reported cases using specific details. The goal is pattern recognition across cases.
Framework to use:
- "Consistent with previous reports, our patient demonstrated..."
- "Unlike the majority of reported cases, our patient..."
- "This case adds to the growing evidence that..."
Pearl: When citing cases, mention specific details (patient age, comorbidity, intervention, outcome) rather than just citing the reference number. This shows you've actually analyzed the literature, not just listed references.
3. Mechanistic or Pathophysiological Explanation
Explain the biological plausibility of your observation. In critical care, this often involves:
- Pharmacodynamics/pharmacokinetics
- Inflammatory cascades
- Organ cross-talk
- Hemodynamic principles
Example for context:
"The improvement in our patient's cardiac function following thyroid replacement therapy aligns with the known effects of thyroid hormone on myocardial contractility through regulation of calcium-handling proteins and β-adrenergic receptors. The prolonged critical illness likely exacerbated the hypothyroid state through suppression of the hypothalamic-pituitary axis..."
Oyster: Don't speculate beyond what's scientifically plausible. Phrases like "We hypothesize that..." are acceptable if followed by mechanistic reasoning, not wild conjecture.
4. Clinical Implications and Practice Points
Translate your case into practical guidance. Use directive language when appropriate.
Effective phrasing:
- "Clinicians should consider..."
- "This case suggests that screening for X may be warranted when..."
- "Early recognition requires attention to..."
- "Our experience indicates that..."
Hack: Include a "Clinical Practice Points" box highlighting 3-5 actionable take-aways. Many journals feature these prominently, and they're highly cited.
5. Limitations and Alternative Explanations
Acknowledge what your case cannot prove. Common limitations in case reports include:
- Single observation (not generalizable)
- Confounding interventions (multiple simultaneous treatments)
- Retrospective data collection
- Incomplete diagnostic workup
- Unavailable long-term follow-up
Pearl: Addressing limitations proactively strengthens rather than weakens your manuscript. It demonstrates critical thinking and prevents reviewers from raising these as major concerns.
Example:
"Several limitations warrant consideration. First, our patient received multiple therapeutic interventions concurrently, making it impossible to determine which specific factor contributed most to recovery. Second, we could not perform genetic testing to confirm the diagnosis definitively. Third, long-term follow-up beyond 6 months was not available."
6. Future Directions
Conclude by pointing toward knowledge gaps that remain. Be specific about what type of evidence is needed.
Weak: "More research is needed."
Strong: "Given the increasing recognition of this syndrome, a prospective registry capturing standardized data elements could help define diagnostic criteria and optimal treatment algorithms. Future studies should focus on biomarkers for early detection and randomized trials comparing therapeutic approaches."
The "So What?" Paragraph: Your Discussion's Climax
Near the end of your discussion, include what I call the "So What?" paragraph—a brief, powerful statement of why busy clinicians should care about your case.
Template:
"The clinical significance of this case lies in [main insight]. In the ICU setting where [contextual challenge], recognition of [key finding] can [impact on patient care]. Our case suggests that [specific recommendation], which may [benefit to patients]."
Example:
"The clinical significance of this case lies in the diagnostic delay of eosinophilic pneumonia due to its radiographic similarity to COVID-19 pneumonia. In the current pandemic setting where COVID-19 remains highly prevalent, recognition of peripheral eosinophilia as a discriminating feature can expedite appropriate corticosteroid therapy. Our case suggests that clinicians should maintain a broad differential diagnosis for acute respiratory failure even when COVID-19 seems likely, which may prevent unnecessary escalation of care and improve outcomes."
Navigating the Submission and Peer-Review Process
From Manuscript to Publication: The Journey
Understanding the editorial and peer-review process transforms rejection from discouragement to education.17,18
Step 1: Choosing the Right Journal
Match your case to journal scope and audience:
Tier 1 journals (NEJM, Lancet, JAMA case reports):
- Extraordinary novelty or clinical impact
- Exceptional teaching value
- Outstanding presentation quality
- Often include imaging or videos
- Rejection rate >90%
Tier 2 journals (specialty journals like Critical Care Medicine, Chest, Intensive Care Medicine):
- Strong cases relevant to the specialty
- Solid literature review and discussion
- Clear clinical message
- Rejection rate 60-80%
Tier 3 journals (case report journals, regional journals):
- Broader acceptance criteria
- Valuable for less common but still educational cases
- Faster publication times
- Rejection rate 30-50%
Pearl: Aim high but be realistic. Having your case published in a specialty journal trumps rejection from a general journal. Publication is the goal; prestige is a bonus.
Hack: Read recent case reports in your target journal before writing. Notice their length, discussion depth, and reference style. Match their format precisely—it signals professionalism.
Step 2: Pre-Submission Checklist
Before clicking "submit," verify:
Ethics and Consent:
- ✓ Informed consent obtained and documented
- ✓ Ethics committee approval (if required by your institution)
- ✓ Complete de-identification (no dates, room numbers, or identifying photos)
- ✓ HIPAA or equivalent privacy regulations followed
Manuscript Completeness:
- ✓ Follows author guidelines exactly (word count, format, sections)
- ✓ CARE checklist completed (available at care-statement.org)<sup>14</sup>
- ✓ All figures/tables cited in text
- ✓ References formatted per journal style
- ✓ Conflict of interest statements completed
- ✓ Author contribution statements included
Quality Checks:
- ✓ Proofread by coauthor (preferably by someone who didn't write the draft)
- ✓ Run through grammar checking software
- ✓ All medical terminology spelled correctly
- ✓ Dosages and lab values double-checked
Oyster: More cases are rejected for poor writing than for insufficient novelty. Have a colleague with strong English skills review your manuscript before submission.
Step 3: Writing an Effective Cover Letter
The cover letter is your sales pitch. It should be concise (one page) and contain:
Paragraph 1: State the manuscript title and type (case report)
Paragraph 2: Explain why this case is significant and why it fits the journal (cite 1-2 recent similar cases from that journal to show you've done your homework)
Paragraph 3: Confirm ethical compliance and state that the manuscript is not under consideration elsewhere
Paragraph 4: Suggest potential reviewers (some journals allow this)—choose experts in the field who don't have conflicts of interest
Example cover letter paragraph:
"We submit for your consideration a case report titled 'Veno-Venous ECMO as Rescue Therapy for Refractory Status Asthmaticus: A Case Report and Literature Review.' This case describes the youngest patient (18 years old) to successfully undergo VV-ECMO for status asthmaticus complicated by barotrauma, filling a gap in the literature regarding ECMO candidacy in pediatric-to-adult transition patients. Given your journal's recent focus on mechanical support in respiratory failure (Smith et al., 2023; Jones et al., 2024), we believe this case will interest your readership."
Step 4: Understanding Editorial Decisions
Immediate rejection (desk rejection): Occurs before peer review. Reasons include:
- Out of scope for the journal
- Insufficient novelty
- Poor writing quality
- Incomplete submission
Action: Revise if needed and submit elsewhere without delay. Don't take it personally—desk rejection rates exceed 50% at many journals.
Sent for peer review: Your manuscript is reviewed by 2-3 experts. Possible outcomes:
- Accept (rare): Celebrate! Occurs in <5% of case reports
- Minor revisions: Addressable changes, high likelihood of acceptance
- Major revisions: Significant concerns, but editors see potential
- Reject with resubmission option: Fundamental issues, but willing to reconsider with substantial changes
- Reject: Manuscript not suitable even with revisions
Pearl: "Major revisions" is good news. Editors don't waste reviewers' time on hopeless manuscripts. They believe your case is publishable if improved.
Step 5: Responding to Reviewers
The revision response letter is as important as the manuscript itself. Follow this template:
Structure:
- Thank the editor and reviewers
- Provide a point-by-point response to each comment
- Indicate where changes were made in the manuscript
- Explain if you disagree with a reviewer (politely and with justification)
Format for each response:
Reviewer 1, Comment 2: "The discussion should include more information about differential diagnoses."
Response: We thank the reviewer for this suggestion. We have expanded the discussion to include a differential diagnosis table (Table 2, page 8) that lists five alternative diagnoses with supporting and refuting features from our case. We have also added text on page 9, lines 15-20 (highlighted in yellow in the revised manuscript) discussing why these alternatives were considered but ruled out.
Pearl: Even when you disagree with a reviewer, make some change that acknowledges their concern. Complete dismissal of reviewer comments rarely results in acceptance.
When to respectfully disagree:
"We appreciate the reviewer's suggestion to include genetic testing results. Unfortunately, genetic testing was not clinically indicated at the time and was not performed. We have added this as a limitation in the Discussion section (page 12, lines 5-7). However, we respectfully maintain that the clinical and radiographic findings were sufficient for diagnosis based on established criteria (Reference 23), which we have now cited."
Oyster: Never write a defensive or emotional response. Wait 24 hours after receiving reviews before drafting your response letter. Reviewers volunteer their time; treat them with respect even when you disagree.
Step 6: Dealing with Rejection
Rejection is part of academic publishing. Even landmark cases were rejected initially. When a manuscript is rejected:
Immediate actions:
- Read the reviews carefully without emotional reaction
- Identify constructive criticism
- Determine if concerns are addressable
- Select the next target journal
Revising after rejection:
- Incorporate valid reviewer feedback before resubmitting elsewhere
- Don't simply send the same manuscript to another journal
- Consider whether the case needs reframing (different focus or message)
Pearl: Track your submissions in a spreadsheet: Journal, Submission Date, Decision, Time to Decision, Reviewer Comments Summary. Over time, you'll identify patterns that improve your success rate.
Step 7: Post-Acceptance Responsibilities
After acceptance:
- Proof reading: Carefully review galley proofs for typesetting errors
- Copyright transfer: Complete forms promptly
- Open access decisions: Determine if you'll pay for open access (if optional)
- Promotion: Share your publication on professional networks, ResearchGate, and social media (many journals encourage this)
- Update coauthors: Ensure all authors receive the publication details
Hack: Request metrics from the journal after 6-12 months (downloads, citations, Altmetric score). These data are useful for your CV and for determining which types of cases generate the most impact.
Pearls, Oysters, and Hacks: A Summary
Pearls (Wisdom to Embrace)
- Message first, case second: Decide your take-home point before writing the first word
- Write for the 2 AM reader: If your case helps clinicians make better real-time decisions, it's valuable
- One case, one message: Resist the urge to extract multiple lessons from a single case
- Tables and figures are your friends: Visual presentation of data is more impactful than text
- The discussion is where you prove your expertise: Show deep understanding, not just case description
- Rejection is redirection: Every rejection teaches you to write better
- Ethics matter: Never compromise patient privacy or fabricate details
- Cite generously but critically: Show you know the literature but can appraise it
Oysters (Pitfalls to Avoid)
- Rarity without utility: "Interesting" ≠ "publishable"
- Exhaustive introductions: Save the literature review for the discussion
- Case presentation overload: Not every vital sign deserves mention
- Discussion as general review: Every sentence must connect to YOUR case
- "More research is needed" without specificity: Lazy conclusion
- Ignoring CARE guidelines: Decreases acceptance likelihood
- Poor response to reviewers: Defensive tone guarantees rejection
- Submitting without proofreading: Typos suggest sloppy clinical thinking
Hacks (Efficiency Strategies)
- Literature tracking spreadsheet: Saves hours during discussion writing
- Read target journal's recent cases before writing: Match their style exactly
- Write the abstract last: Crystallizes your entire manuscript's message
- Use voice dictation for the first draft: Faster than typing, edit later
- Create a personal template: Reuse structure for your next case
- Suggest reviewers who recently published on the topic: Increases relevant feedback
- Join social media groups for academic writing: Learn from others' experiences
- Track your submission metrics: Identify patterns for future success
Conclusion
Writing a compelling case report requires more than encountering an unusual patient—it demands the ability to extract generalizable wisdom from singular clinical experiences. By understanding what makes cases publishable, mastering the structural elements of case reports, conducting thorough literature reviews, crafting insightful discussions, and navigating the peer-review process with professionalism, critical care practitioners can contribute meaningfully to the medical literature.
The case report remains one of the most accessible entry points into medical scholarship, yet mastery of this form requires the same rigor demanded by other research methodologies. As you return to your ICU, view each complex patient not only as a clinical challenge but as a potential teaching opportunity. The question is not whether your patients are interesting, but whether you can articulate why they should matter to the broader medical community.
Final Pearl: The best case reports answer a question that the reader didn't know they had, using a patient they'll never forget.
References
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Vandenbroucke JP. In defense of case reports and case series. Ann Intern Med. 2001;134(4):330-334.
McCarthy LH, Reilly KEH. How to write a case report. Fam Med. 2000;32(3):190-195.
Rison RA, Kidd MR, Koch CA. The CARE (CAse REport) guidelines and the standardization of case reports. J Med Case Rep. 2013;7:261.
Cohen H. How to write a patient case report. Am J Health Syst Pharm. 2006;63(19):1888-1892.
Green BN, Johnson CD. How to write a case report for publication. J Chiropr Med. 2006;5(2):72-82.
Florek AG, Dellavalle RP. Case reports in medical education: a platform for training medical students, residents, and fellows in scientific writing and critical thinking. J Med Case Rep. 2016;10:86.
Sen M, Honavar SG, Sharma N, Sachdev MS. COVID-19 and eye: a review of ophthalmic manifestations of COVID-19. Indian J Ophthalmol. 2021;69(3):488-509.
Peh WC, Ng KH. Writing a case report. Singapore Med J. 2010;51(1):10-13.
Helmons PJ, Kosterink JGW, Daniels CE. Principles for valid case reports. J Med Case Rep. 2011;5:252.
Agha RA, Fowler AJ, Saeta A, et al. The SCARE statement: consensus-based surgical case report guidelines. Int J Surg. 2016;34:180-186.
Pierson DJ. The top 10 reasons why manuscripts are not accepted for publication. Respir Care. 2004;49(10):1246-1252.
Abu-Zidan FM, Abbas AK, Hefny AF. Clinical "case series": a concept analysis. Afr Health Sci. 2012;12(4):557-562.
Riley DS, Barber MS, Kienle GS, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218-235.
Sayre JW, Toklu HZ, Ye F, Mazza J, Yale S. Case reports, case series—from clinical practice to evidence-based medicine in graduate medical education. Cureus. 2017;9(8):e1546.
DeMaria AN. The case report: an endangered species? J Am Coll Cardiol. 2011;57(6):741-742.
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Author Contributions: This review synthesizes established principles from medical education and writing methodology literature, adapted specifically for critical care practitioners. The authors declare no conflicts of interest.
Acknowledgments: The authors thank the countless trainees and colleagues whose questions about case report writing inspired this comprehensive guide.
APPENDIX: Practical Tools and Checklists
APPENDIX A: The CARE Checklist for Case Reports
The CARE (CAse REport) guidelines provide a standardized framework for case report writing. Use this checklist before submission:14
| Section/Topic | Item # | Checklist Item Description |
|---|---|---|
| Title | 1 | The words "case report" or "case study" should appear in the title along with the key clinical finding |
| Key Words | 2 | 2-5 key words that identify topics in this case report |
| Abstract | 3a-3d | Introduction, Patient information, Clinical findings, Timeline, Diagnostic assessment, Therapeutic intervention, Follow-up and outcomes, Discussion (including key take-aways), Patient perspective |
| Introduction | 4 | Brief background summary with 1-2 references explaining the importance |
| Patient Information | 5 | De-identified demographic and clinical information; chief complaint; relevant medical, family, and psychosocial history including genetic information; relevant past interventions and their outcomes |
| Clinical Findings | 6 | Describe significant physical examination and clinical findings |
| Timeline | 7 | Depict important dates and times (consider a figure or table) |
| Diagnostic Assessment | 8 | Diagnostic methods, test results, challenges in diagnosis, diagnostic reasoning including differential diagnoses |
| Therapeutic Intervention | 9 | Types of interventions (pharmacologic, surgical, preventive, self-care); administration, dosages, duration; changes in intervention with explanations |
| Follow-up and Outcomes | 10 | Clinical outcomes, patient-reported outcomes, important follow-up diagnostic test results; adherence and tolerability |
| Discussion | 11a-11d | Strengths and limitations; relevant literature; rationale for conclusions; primary take-away lessons from this case |
| Patient Perspective | 12 | When appropriate and possible, include patient or family perspective on treatment/outcomes |
| Informed Consent | 13 | Did patient give informed consent? If not, explain why |
APPENDIX B: Case Report Template for Critical Care
Use this template as a starting framework. Adapt based on journal requirements.
TITLE: [Condition/Finding] in [Patient Population]: A Case Report and Literature Review
ABSTRACT (250 words)
Background: [1-2 sentences on the condition's significance]
Case Presentation: [Patient demographics, presentation, key findings, intervention, outcome]
Conclusion: [Primary take-home message]
Keywords: [5 terms]
INTRODUCTION (250-300 words)
Paragraph 1: Define the condition and establish clinical importance
Paragraph 2: Describe what's controversial, unknown, or challenging
Paragraph 3: State what gap this case fills
CASE PRESENTATION (400-600 words)
Patient Demographics: [Age, sex, relevant history - de-identified]
Presentation: [Chief complaint, symptoms, timeline]
Examination: [Vital signs, key physical findings]
Investigations: [Laboratory, imaging, diagnostic tests - consider table]
Management: [Interventions with rationale, timeline - consider figure]
Outcome: [Clinical course, complications, disposition, follow-up]
DISCUSSION (600-800 words)
Paragraph 1: Restate the principal finding
Paragraphs 2-3: Compare with existing literature (cite specific similar cases)
Paragraphs 4-5: Explain pathophysiological mechanism
Paragraph 6: State clinical implications and practice points
Paragraph 7: Acknowledge limitations
Paragraph 8: Future directions
CONCLUSION (100-150 words)
Restate main lesson and actionable take-away
REFERENCES
[Formatted per journal style, typically 15-25 references for case reports]
APPENDIX C: Literature Review Tracking Spreadsheet Template
Create this in Excel or Google Sheets:
| Author, Year | Journal | Patient Age/Sex | Presentation | Diagnosis Method | Intervention | Outcome | How It Relates to My Case | Quality (High/Med/Low) |
|---|---|---|---|---|---|---|---|---|
| Smith 2022 | Crit Care Med | 45/M | Septic shock | Blood culture | Polymyxin B | Survived | Similar presentation, different organism | High |
| Jones 2021 | Chest | 52/F | ARDS | BAL | Steroids | Died | Different intervention, worse outcome | Medium |
| [Your case] | - | 48/F | Septic shock + ARDS | Blood culture + BAL | Polymyxin B + Steroids | Survived | Novel combination therapy | - |
How to use this:
- Fill in as you review each paper
- Sort by relevance to identify the most important cases to cite
- Use the "How It Relates" column to draft comparison sentences for your discussion
- Quality assessment helps you prioritize which cases to emphasize
APPENDIX D: Discussion Section Outline Template
Paragraph-by-paragraph guide for critical care case discussions:
¶1 - PRINCIPAL FINDING (3-4 sentences)
- Opening sentence: "This case demonstrates that [main finding]..."
- Why it matters clinically
- Brief statement of outcome
¶2 - LITERATURE CONTEXT (5-7 sentences)
- "A comprehensive literature search identified X cases of [condition]..."
- Summarize patterns across cases
- Table reference if you created one comparing cases
¶3 - COMPARISON WITH YOUR CASE (5-7 sentences)
- "Similar to previously reported cases, our patient..."
- "Unlike most reports, our case..."
- "Our findings extend prior observations by..."
¶4 - PATHOPHYSIOLOGY/MECHANISM (6-8 sentences)
- "The [finding] in our patient can be explained by..."
- Cite mechanistic studies
- Connect pathophysiology to clinical presentation
¶5 - DIAGNOSTIC CONSIDERATIONS (5-6 sentences)
- "Diagnosis of [condition] requires..."
- Discuss differential diagnoses if relevant
- Mention any diagnostic challenges or pearls
¶6 - THERAPEUTIC IMPLICATIONS (5-7 sentences)
- "Management of [condition] typically involves..."
- "In our case, [intervention] was chosen because..."
- "This approach resulted in..."
¶7 - CLINICAL IMPLICATIONS (4-5 sentences)
- "This case has several important clinical implications..."
- Bullet or number 3-4 specific actionable points
- "Clinicians should consider..."
¶8 - LIMITATIONS (3-4 sentences)
- "Several limitations deserve mention..."
- List 2-3 specific limitations honestly
- Don't over-apologize
¶9 - FUTURE DIRECTIONS (3-4 sentences)
- "Future research should focus on..."
- Be specific about study design needed
- Avoid generic "more research needed"
APPENDIX E: Common Reviewer Comments and How to Address Them
Understanding common criticisms helps you preemptively strengthen your manuscript:
| Common Reviewer Comment | What It Really Means | How to Address |
|---|---|---|
| "The novelty is unclear" | Your case seems similar to published cases | Explicitly state in the introduction and discussion what is unique; create a comparison table |
| "The discussion is too general" | You're reviewing the condition, not discussing YOUR case | Rewrite to connect every sentence back to your case; use phrases like "In our patient..." |
| "The literature review is incomplete" | You missed important similar cases | Perform a more systematic search; show your search strategy |
| "The clinical message is unclear" | Your take-home point is buried or absent | Create a "Clinical Practice Points" box; rewrite the conclusion more forcefully |
| "The case lacks sufficient detail" | Key clinical information is missing | Add laboratory values, imaging descriptions, treatment dosages/durations |
| "This reads like a medical record" | Too much unnecessary detail; poor narrative flow | Edit for relevance; remove non-contributory details; improve transitions |
| "The writing needs improvement" | Grammar, spelling, or clarity issues | Have a native English speaker review; use editing software |
| "The figures are poor quality" | Images are blurry, poorly labeled, or don't add value | Use high-resolution images; add arrows/labels; ensure figures directly support your message |
| "Alternative explanations not considered" | You seem biased or haven't thought critically | Discuss differential diagnoses; acknowledge alternative interpretations; show balanced thinking |
| "The references are outdated" | You cited mostly older papers | Search for recent literature; cite papers from the last 3-5 years when available |
APPENDIX F: Journal Selection Decision Tree
Use this flowchart approach to select your target journal:
START: Assess your case
Question 1: Is this the FIRST reported case ever OR does it fundamentally change practice?
- YES → Consider: NEJM, Lancet, JAMA Case Reports, BMJ Case Reports
- NO → Go to Question 2
Question 2: Is there strong educational value for specialists in your field?
- YES → Consider: Specialty journals (Critical Care Medicine, Intensive Care Medicine, Chest, AJRCCM)
- NO → Go to Question 3
Question 3: Is the case relevant primarily to your region or practice setting?
- YES → Consider: Regional medical journals, institutional journals
- NO → Go to Question 4
Question 4: Is rapid publication important?
- YES → Consider: Open-access case report journals (Journal of Medical Case Reports, Cureus, BMC Case Reports)
- NO → Consider any appropriate journal based on scope
PEARL for journal selection: Check each journal's:
- Impact Factor (not everything, but matters for your CV)
- Time to publication (check recent articles' submission-to-publication dates)
- Open access options (affects discoverability)
- Indexing (PubMed/MEDLINE indexing is crucial)
APPENDIX G: Pre-Submission Final Review Checklist
Print this and check each item before clicking "Submit":
CONTENT QUALITY
- [ ] Title includes "case report" and the key finding
- [ ] Abstract stays within word limit and includes all required elements
- [ ] Introduction clearly states why this case merits publication
- [ ] Case presentation includes all CARE checklist elements
- [ ] Timeline of events is clear (figure/table if complex)
- [ ] Discussion connects to your case throughout (every paragraph)
- [ ] Literature review is current (>50% of references from last 5 years)
- [ ] Limitations acknowledged without over-apologizing
- [ ] Conclusion reinforces the primary message
- [ ] Take-home message is crystal clear
TECHNICAL REQUIREMENTS
- [ ] Word count within journal limits
- [ ] Reference format matches journal style exactly
- [ ] Figures/tables are high resolution and properly labeled
- [ ] All figures/tables cited in text
- [ ] Line numbers included (if required)
- [ ] Page numbers included
- [ ] Blinded version created (if required for peer review)
ETHICS & COMPLIANCE
- [ ] Informed consent obtained and documented
- [ ] Patient completely de-identified (no dates, no identifiable images)
- [ ] IRB approval obtained (if required by institution)
- [ ] CARE checklist completed
- [ ] Conflict of interest statements completed for all authors
- [ ] Author contributions specified
- [ ] Funding sources declared (or "none" stated)
WRITING QUALITY
- [ ] Proofread by at least one other person
- [ ] Spell-checked (medical terms verified)
- [ ] Grammar-checked with software
- [ ] Abbreviations defined at first use
- [ ] Tense consistent (typically past tense for case, present for discussion)
- [ ] Active voice used predominantly
- [ ] No plagiarism (run through detection software if available)
SUBMISSION MATERIALS
- [ ] Cover letter written
- [ ] Title page with all author information
- [ ] Manuscript file (blinded if required)
- [ ] Figures uploaded separately (if required)
- [ ] Tables uploaded separately (if required)
- [ ] Supplementary materials prepared (if any)
- [ ] Suggested reviewers list (if allowed)
- [ ] Responses to pre-submission queries completed
APPENDIX H: Responding to Revisions - Sample Template
Use this structure when responding to reviewers:
Date: [Submission Date]
Manuscript Title: [Full Title]
Manuscript ID: [If assigned]
Dear Dr. [Editor Name],
Thank you for the opportunity to revise our manuscript titled "[Title]." We appreciate the thoughtful comments from the reviewers, which have helped us significantly improve the quality of our work. Below, we provide a point-by-point response to each comment. Changes in the revised manuscript are highlighted in yellow.
REVIEWER 1
Comment 1: [Paste reviewer comment]
Response: [Your response explaining how you addressed it]
Changes made: [Specific location of changes: "Page X, lines Y-Z" or "New Table 2"]
Comment 2: [Next comment]
Response:
Changes made:
[Continue for all comments]
REVIEWER 2
[Same format]
EDITOR'S COMMENTS (if any)
[Same format]
SUMMARY OF MAJOR REVISIONS:
- [Key change 1]
- [Key change 2]
- [Key change 3]
We believe these revisions have substantially strengthened the manuscript and hope it is now suitable for publication in [Journal Name]. We look forward to your decision.
Sincerely,
[Your name and credentials]
Corresponding Author
APPENDIX I: Metrics to Track Post-Publication
After your case report is published, track these metrics for your academic portfolio:
Immediate Metrics (0-3 months):
- Number of downloads/views
- Altmetric score (social media attention)
- Press coverage (if any)
Medium-term Metrics (3-12 months):
- Citations in Google Scholar
- Citations in PubMed
- Journal impact factor at time of publication
- Sharing on professional networks (ResearchGate, LinkedIn)
Long-term Metrics (1-5 years):
- Total citation count
- H-index contribution
- Clinical guideline mentions
- Inclusion in systematic reviews or meta-analyses
- Educational use (cited in teaching materials)
Where to track:
- Google Scholar (free, comprehensive)
- PubMed (for biomedical citations)
- Scopus (if institutional access available)
- Web of Science (if institutional access available)
- Altmetric (tracks social/media attention)
PEARL: Even a single citation in a clinical guideline has more practice-changing impact than 100 citations in other case reports. Quality of citations matters.
APPENDIX J: Red Flags That Predict Rejection
Learn to recognize these warning signs BEFORE you invest time writing:
RED FLAGS IN THE CASE ITSELF:
- ❌ Multiple similar cases already published in the last 2 years
- ❌ Outcome was exactly what's expected (no surprise or lesson)
- ❌ Diagnosis made by excluding alternatives rather than confirming
- ❌ Multiple concurrent interventions making causality unclear
- ❌ Incomplete workup (missing obvious diagnostic tests)
- ❌ No follow-up data (lost to follow-up immediately)
- ❌ Ethical concerns (dubious consent, experimental treatment without approval)
RED FLAGS IN YOUR WRITING:
- ❌ Can't articulate the main message in one sentence
- ❌ The "so what?" isn't obvious by the end of the abstract
- ❌ Discussion reads like a textbook chapter on the condition
- ❌ More than 3 take-home points (message is diluted)
- ❌ References are mostly >10 years old
- ❌ You haven't read the target journal's recent case reports
- ❌ Colleagues' feedback is lukewarm ("interesting" not "you must publish this!")
If you identify multiple red flags: Consider whether revision can address them, or whether your effort is better spent on a different case.
APPENDIX K: Advanced Tips for Experienced Writers
Once you've published several case reports, elevate your craft:
1. The "Case Series" Strategy
If you encounter 3+ similar cases, consider a case series rather than individual reports. Case series:
- Carry more weight than single cases
- Allow pattern identification
- Are easier to publish in higher-tier journals
- Require systematic comparison tables
2. The "Visual Abstract" Advantage
Create a single-figure visual summary of your case:
- Post on social media when published
- Increases engagement 5-10× compared to text
- Many journals now encourage or require these
- Tools: PowerPoint, Canva, BioRender
3. The "Teach One, Learn One" Approach
Mentor trainees through case report writing:
- They do the literature review and first draft
- You provide senior authorship and critical revision
- Builds your publication record while teaching
- Creates sustainable scholarly productivity
4. The "Commentary Response" Opportunity
After publishing, watch for:
- Letters to the editor about your case
- Invitations to write responses or commentaries
- Requests for interviews or podcasts
- These extend your case's impact
5. The "Systematic Case Review" Evolution
After publishing several case reports in a niche area:
- Conduct a systematic review of all published cases (including yours)
- This becomes a highly-cited review article
- Establishes you as an expert in that specific presentation
- Example: "Extracorporeal Support in Refractory Status Asthmaticus: A Systematic Review of 47 Cases"
Final Thoughts: From Case Report to Career
For critical care practitioners, case reports serve multiple purposes beyond knowledge dissemination:
Early Career:
- Low barrier to publication (compared to original research)
- Teaches scientific writing fundamentals
- Builds PubMed-indexed publication record
- Demonstrates scholarly productivity for promotion
Mid Career:
- Establishes expertise in niche areas
- Facilitates networking with researchers in your field
- Provides teaching material for trainees
- Contributes to guideline development when cited
Late Career:
- Documents rare experiences for posterity
- Mentorship vehicle for junior colleagues
- Solidifies legacy in specific clinical areas
- Often becomes highly cited as "classic cases"
The case report is not merely a publication—it's a commitment to learning from every patient and teaching the next generation. As critical care practitioners, we are privileged to care for some of medicine's most complex and critically ill patients. Each case carries potential lessons. The question is whether we'll take the time to extract and share that wisdom.
The ultimate PEARL: Every expert was once a beginner who published their first case report. Your contribution to the literature begins with a single case and a willingness to write. Start today.
Suggested Reading for Continued Learning
For those wishing to deepen their understanding of medical writing:
Books:
- Pierson DJ. How to Write and Publish a Scientific Paper - Gold standard reference
- Goodman NW, Edwards MB. Medical Writing: A Prescription for Clarity - Excellent for improving writing quality
- Zeiger M. Essentials of Writing Biomedical Research Papers - Comprehensive guide
Online Resources:
- CARE Statement website (www.care-statement.org) - Free checklist and guidelines
- EQUATOR Network (www.equator-network.org) - Reporting guidelines for all study types
- AuthorAID (www.authoraid.info) - Free mentoring for researchers in developing countries
- Council of Science Editors (www.councilscienceeditors.org) - Style and ethics resources
Courses:
- Coursera: "Writing in the Sciences" (Stanford University) - Free, excellent fundamentals
- EASE (European Association of Science Editors) webinars - Regular free sessions
- AMWA (American Medical Writers Association) workshops - Professional development
The journey from clinician to published author is achievable. With the framework provided in this guide, commitment to excellence in writing, and willingness to learn from rejection, your next interesting patient could become your next published case report.
Now go write.
