Table 1 The CARE guidelines checklist
From: The CARE guidelines: consensus-based clinical case reporting guideline development
The Narrative: A case report tells a story in a narrative format that includes the presenting concerns, clinical findings, diagnoses, interventions, outcomes (including adverse events), and follow-up. The narrative should include a discussion of the rationale for any conclusions and any take-away messages. | ||
|---|---|---|
Item name | Item no. | Brief description |
Title | 1 | The words “case report” (or “case study”) should appear in the title along with phenomenon of greatest interest (eg, symptom, diagnosis, test, intervention) |
Keywords | 2 | The key elements of this case in 2-5 words |
Abstract | 3 | a) Introduction—What does this case add? |
b) Case Presentation: | ||
- The main symptoms of the patient | ||
- The main clinical findings | ||
- The main diagnoses and interventions | ||
- The main outcomes | ||
c) Conclusion—What were the main “take-away” lessons from this case? | ||
Introduction | 4 | Brief background summary of this case referencing the relevant medical literature |
Patient Information | 5 | a) Demographic information (eg, age, gender, ethnicity, occupation) |
b) Main symptoms of the patient (his or her chief complaints) | ||
c) Medical, family, and psychosocial history—including diet, lifestyle, and genetic information whenever possible, and details about relevant comorbidities including past interventions and their outcomes | ||
Clinical Findings | 6 | Describe the relevant physical examination (PE) findings |
Timeline | 7 | Depict important dates and times in this case (table or figure) |
Diagnostic Assessment | 8 | a) Diagnostic methods (eg, PE, laboratory testing, imaging, questionnaires) |
b) Diagnostic challenges (eg, financial, language/cultural) | ||
c) Diagnostic reasoning including other diagnoses considered | ||
d) Prognostic characteristics (eg, staging) where applicable | ||
Therapeutic Intervention | 9 | a) Types of intervention (eg, pharmacologic, surgical, preventive, self-care) |
- Administration of intervention (eg, dosage, strength, duration) | ||
- Changes in intervention (with rationale) | ||
Follow-up and Outcomes | 10 | a) Summarize the clinical course of all follow-up visits including |
- Clinician and patient-assessed outcomes | ||
- Important follow-up test results (positive or negative) | ||
- Intervention adherence and tolerability (and how this was assessed) | ||
- Adverse and unanticipated events | ||
Discussion | 11 | a) The strengths and limitations of the management of this case |
b) The relevant medical literature | ||
c) The rationale for conclusions (including assessments of cause and effect) | ||
d) The main “take-away” lessons of this case report | ||
Patient Perspective | 12 | The patient should share his or her perspective or experience whenever possible |
Informed Consent | 13 | Did the patient give informed consent? Please provide if requested |