Writing Your Case Report

Lisa Zaynab Killinger, DC

Palmer Center for Chiropractic Research

Remember
A case report describes the identification, management, or unusual presentation of a condition or clinical scenario.

Case Reports...
Should educate or share important experiences with others Are the foundation for future studies Are healthcare story telling

Choosing your Case

An unusual occurrence or presentation An unexpected outcome (The Good, the Bad, or the Ugly!) A new approach to an old problem (If you used an uncommon technique, or added a new intervention, etc)

Stay within the limits of Case Reports in your writing:

Not generalizable Describes what happened in one case, nothing more. Does not rule out placebo effect Does not prove effectiveness of treatment

Building Your Case Report:

Abstract Introduction Methods/Case Report* Intervention and Outcome Discussion Conclusions

Introduction
Introduces the case/condition of interest Reviews and cites the scientific literature on the topic (Chiro./Non-chiro. Lit.) States the etiology/common txs./prognosis Includes recent, high quality references (articles are better than books!)

Did you answer:

What is known about the condition of interest?

Case Report or Clinical Features Section

Describes the history and exam of the patient (Thoroughly enough to convince the reader that you arrived at the appropriate clinical impression and management plan!)

Did you answer:

How did patient present, what were your exam findings, and what was your clinical impression?

Methods or Intervention & Outcome

This section must describe the care given in enough detail that the reader could easily duplicate the care. (And, hopefully, duplicate your outcomes!)

Did you answer:

What did you do, when, and how?

The Outcome Piece

Describe the changes observed in the pt. Lists results on outcome measures used (I.e: Rand-36 or Visual Analog scores) Describes changes in health status, pain, symptoms, unexpected results, etc.

Visual Analog Scale :VAS (Global Well-Being Scale, etc.) or Verbal Analog Scale
Simply a 10 cm. line

Rand-36 (SF-36)
A 36 question survey; patient fills it out A valid and reliable measure of the patients general health status A shorter 12 question form is available Offers a great deal of information on patients emotional and physical well being, energy, pain, etc.

The Outcome (Results) Section Answers:

How did you document change (positive or negative results) in this case?

Discussion Includes:
Interpretations of your findings Comparison of your case with other studies (The ones cited in your intro!) Rationale for management plan Discussion of limitations/flaws in your study Discuss possible reasons for the results you observed (other variables,placebo, etc.)

The Discussion Section Answers:

How does your case confirm/refute previous studies on this topic, and why did you do what you did?

Conclusions
Tells the reader what was learned through this case Describes why the case is significant Suggests a direction for future studies. Dont make unsubstantiated claims!!!

The Conclusion Section Answers:

What is the next step

in studying this topic?

How your case report will be judged for quality :

Use of outcomes assessments Lengthy follow-up Discussion of its limitations! (If you dont, we will!)

More Measures of Quality:

Thorough description of methods Discussion of the placebo effect Good quality, recent references!!

A Word About References

References should be numbered in the order they appear in the article References need to be listed immediately following any phrase) from another author or article. All statements of fact MUST be referenced. Research articles are preferred, then textbooks, then manuals, popular press articles, etc.

StyleScientific Pulications/Articles
Authors Last name then first initial, <comma> other authors <Period> Title of article (only first letter capitalized) <period> Name of Journal (using standard abbrev and italicized) <period>year of publication <semicolon>volume number and issue number (issue # in parentheses)<colon>page numbers <period>

Hurwitz EL, Coulter ID, Adams AH, et al. Use of chiropractic services from 1985-1991 in the United States and Canada. Am J Public Health. 1998;88(5):771-776.

Style-Textbooks
Author last name and first initial<period>Name of Book (Italicized; with each main word capitalized) <period>Edition number <period>City/country of publication <colon>Publishers name <semicolon>Year of pubication <colon> page numbers <period>

Peters T. The Pursuit of Wow! New York:Vintage Books;1994.

Some things NOT to do when writing your case report...

DONT
Write as if you are promoting your technique, product or clinic (case reports are not advertisements) Submit without you AND others proofreading your paper Use patients or doctors name Try to generalize Say that you proved effectiveness of chiropractic!

Whats wrong with this picture? Find it and Fix it!

 ...This case study demonstrates that chiropractic is an effective treatment for multiple sclerosis.

...In this case, chiropractic adjustments to the upper cervical spine were effective in resolving the infantile colic.

Asthma is the most common chronic condition in children, responsible for staggering healthcare expenditures, and thousands of deaths per year in this country alone. (?)

The cervical films showed a C3 PRI.

What goes where? For each sentence that follows, decide into which section of the case study (e.g: methods, intro) it would most appropriately fit.

In this case, we observed a decrease in the number and severity of headaches..

Asthma is the most common chronic condition in children, responsible for staggering healthcare expenditures, and thousands of deaths per year in the United States alone. (2)

Recent studies have shown chiropractic care to be an effective treatment for chronic tension-type headaches. (13, 14) The results observed in this case, confirm the findings of these earlier studies.

Typically, medical management of asthma consists primarily of pharmaceutical interventions including....

Pace Yourself
This week and next: Choose your case As soon as you choose, start writing intervention and outcomes sections (from the patient file) Allow yourself at least 10-20 total hours to complete this case report Start collecting articles/references on the topic of your case for your intro section (need at least 5-15) As soon as you have articles, start circling sentences to use in your paper (statements from the intro and the results)

Dont forget your abstract!

Written last; after the paper is done. Includes a main idea/sentence or two from each section: Intro, Intervention, Outcome, Discussion, etc. Should be brief and succinct Catches readers attention (Answers: Why should you want to read this paper?)

Remember
This is NOT Dr. Killingers assignment Dont come ask me about due dates, page lengths, grading criteria, etc. Dont turn your paper in to me!! All questions about the assignment should be directed to your CCC instructor.