02B. Case Reports in an Evidence-based World

Focus Area: Integrative Approaches to Care Case reports have helped identify effects from interventions and recognize new or rare diseases. Data from case reports—increasingly published in indexed medical journals—are beginning to be systematically collected and reported. However, the quality of published case reports is uneven. One study evaluated 1316 case reports from four emergency medicine journals and found that more than half failed to provide information related to the primary treatment. Case reports written without reporting guidelines (with the exception of harms) are insufficiently rigorous to guide clinical practice, inform research design, or be aggregated for data analysis. This analysis was conducted to develop and implement systematic reporting guidelines for case reports. We followed published recommendations for guideline development using a modified Delphi process with (1) a literature review and interviews generating guidelines items, (2) an October 2012 face-to-face consensus meeting to draft reporting guidelines, and (3) post-meeting feedback and guideline finalization. The CARE (CAse REport) guidelines were developed in a consensus-based process and represent essential information necessary to improve the quality of case reports. These guidelines are generic and will need extensions for specific specialties and purposes. Feedback from use of the guidelines in 2013, though positive, is limited. The analysis of systematically aggregated information from patient encounters may provide scalable, data-driven insights into what works for which patients, transforming how we think about evidence and its creation, diffusion, and use.