The Crisis of Case Reports

Abstract

The editorial evaluation of two manuscripts recently submitted to CHEST included these comments:“The Editors and the reviewers believe that certain data in your case report should be published. However, the major requirement for recording single cases in this journal (and most periodicals) is the uniqueness of the observations; the review material in your paper is not essential. Moreover, the Editorial Board has assigned the highest priority to those reports which present vital information with judicious brevity. We recommend significant reduction in the length of the case history and deletion of findings which are only casually related to your theme. The number of references can be sharply decreased by citing a few references to recent articles which contain a comprehensive review of the literature.” The letter to the second author stated, “Your report should be abbreviated so that emphasis is upon the unique aspects of this case. These instructive features should be underscored in succinct language in the discussion. Incidentally, readership interest is greatly enhanced by such brevity. We should be pleased to review a manuscript which is approximately one-half the length of the present one.” The current crisis related to single case reports was the subject of deliberation at the last meeting of the Editorial Board. The volume of reports submitted to the Selected Report department of this journal in recent months has been so very large that it may soon become impossible to meet the publication timetable which characterizes our other sections. In the judgment of the Editors, it would be a disservice to clinical investigators to limit drastically the number of these communications accepted for publication, since a well-prepared case report has significant clinical potential in the continuing education of the chest physician. The Editorial Board concluded that a major cause for the dilemma was the fact that the format of the case report is possibly the most abused and misunderstood form of medical communication. Unfortunately, it is still fashionable in some quarters to include an exhaustive “review of the literature,” so that introduction, discussion, and the references bear the stigma of this archaic literary style. We assume that conscientious research in the library has preceded preparation of the text, but surely these scholarly labors need not be documented in extenso. The scientific value of case reports depends upon documentation of new concepts or the modification of accepted principles. Whenever possible, the case presentation should be brief so that the reader's attention is directed to the discussion and conclusions. An “interesting” case which does not shed new light upon a disease previously described may be ideal material for Grand Rounds, but today few editors can defend the publication of “the forty-third example” of a particular syndrome. It is far more difficult to prepare a succinct report with a minimum of illustrations than a lengthy manuscript which is profusely illustrated. If this more demanding task is not assumed by authors, valuable information may not reach the clinician because of lack of journal space. In most instances an excellent case report can be contained in one printed page. The Editors, therefore, urge that case reports submitted to CHEST contain approximately 500 words, a maximum of one or two illustrations and approximately six references. Manuscripts prepared in this fashion can be of enormous assistance to us in honoring the author's legitimate request for the briefest possible time lag between manuscript acceptance and publication.