Clinical case reporting in sports and exercise medicine

Abstract

Introduction With the emergence of robust clinical research during this century and wide acceptance of the principles of evidence-based medicine, clinical case reports have been regarded with ambivalence. 1 2 3 After all, it can be argued that they offer no credible evidence on the rate of clinical events, and no comparison or control group. Furthermore, they are severely limited as a way of understanding risk factors and causes of disease, or efficacy of therapeutic or preventative interventions. Despite these arguments clinicians often prefer to learn from case reports and use them as vehicle for continuing medical education. Historically, case reports have played an important role in the medical literature and from the 1940’s- 1970’s comprised approximately 13% of articles in leading medical journals.2 The Lancet, The New England Journal of Medicine and Annals of Internal Medicine often publish clinical case reports as letters or even as original articles or through “clinical problem solving” platforms. The British Journal of Medicine even has an electronic journal dedicated entirely to clinical case reporting (www.casereports.bmj.com/). There are numerous reasons for the documentation of case report (Table 1). A case report can mark the beginning of a case series and eventually lead to an epidemiological study, clinical trials or intervention studies. Sometimes case reports are the only source of information on rare or interesting events; indeed our understanding of HIV disease began with the description of a single case.4 Case reports can entertain and encourage clinicians to think wider, to generate a hypothesis, and they are valuable as part of a comprehensive database of other case reports which can be searched when necessary.