The Decline of the Case Report: How Did We Get Here and What Lies Ahead?

Abstract

The oldest known piece of medical literature is a primitive document from Egyptian antiquity that described a number of patients with acquired and congenital deformities of the head and trunk.1 This format was adopted by health care providers throughout the world and was refined over generations to become the modern-day case report. This tried-and-true medium for documenting clinical experiences has served as a guide for clinical decision-making for millennia, yet a new dawn of medicine is upon us, and the case report is slowly fading from the medical literature. The case report is an immensely useful subset of the plastic surgery literature, as it can provide insights into authors’ philosophies regarding patient care. These philosophies may vary greatly across institutions; thus, the detailed, narrative format afforded by case reports allows readers to be exposed to novel concepts in lieu of traveling to other institutions. In addition, case reports are helpful to surgeons looking for information regarding the treatment of rare pathologies (Table 1). Oftentimes, the scarcity of said pathologies limits their potential to be investigated in the form of high level-of-evidence studies. As a result, plastic surgeons frequently employ case reports and consult their colleagues when developing treatment plans for these patients. Table 1. - Strengths and Limitations of the Case Report Format Strengths Limitations Provides unique insight into patient care Negatively affects journal impact factor Important for rare cases not well-represented in the literature Overwhelms journal reviewersLower-quality evidence when compared with other studies The decline of the case report likely stems from several factors. From the perspectives of plastic surgery journals, the ever-increasing emphasis to publish research and the limited time investment required to write case reports by authors has resulted in exponential increases in the number of manuscripts submitted to journals. As a result, the ability of editorial staff to review each manuscript in a timely fashion has decreased greatly.2 In addition, the advent of metrics such as impact factors has led journals to preferentially accept articles that are likely to be highly cited or to trend on social media platforms. Case reports, despite accruing many reads, generally have a deleterious effect on impact factor as they are relatively poorly cited when compared with higher-level-of-evidence research articles.3 As a result, many journals have largely absolved themselves of the limitations of the traditional case report and have stopped accepting the format altogether.4 Some journals have attempted to preserve the case report by implementing modifications to the traditional format. Most commonly, journals will only accept case reports in the form of a hybridized clinical presentation–subject review format. Recently, innovative video-based case reports have become the standard for several journals across surgical subspecialties. In addition to providing more instructive technical pearls, this new modality has the added benefit of ensuring the legitimacy of the case, as increased pressures to publish have led some authors to write about falsified clinical experiences.5 For the first time in history, the future of the case report within the field of plastic surgery is uncertain. It remains to be seen how the decline of the case report format will affect plastic surgeons moving forward. Further investigations are necessary to establish novel channels for sharing in-depth clinical experiences among plastic surgeons. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. There were no sources of support for this work.