What is a Case Study, and How Should It Be Formatted When Writing for Publication?

Read the accompanying case report to this article here.

Case study reports are valuable teaching resources for practitioners and students, and are written to discuss such topics as new technologies, procedures and imaging techniques, novel uses of technology and equipment, and unusual clinical case scenarios. They are usually written by practitioners who have had clinical interactions in the procedure, and understand the challenges and technical considerations of the case. Case studies allow staff and students to make critical contributions to the body of knowledge in cardiovascular medicine and promote new ideas to their peers.

A case study is a succinct presentation that includes clinical scenarios, treatments, and outcomes. The case report should include a patient’s history and physical, diagnostic imaging studies, the procedural indication, and an introduction into the intervention or procedure performed. The case study should then describe the technical steps of the procedure, treatment, or intervention that was performed.¹ Case reports should also provide concise, clinically relevant reviews of the literature on the topic, and the patient outcome. Common reasons for publishing a case include:

1. An introduction to a new technology or procedure;

2. An unexpected event in the course observing or treating a patient;

3. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect;

4. Unique or rare features of a disease;

5. Unique interventional, therapeutic, or procedural approaches;

6. Anomalous anatomy or a variation of anatomical structures;

7. An adverse response to therapies and the treatment provided.²

When writing up a case study, patient anonymity is also an important requirement. Remember not to disclose any information that might reveal the identity of the patient. Whenever possible, it is beneficial to obtain informed consent to avoid breaches in patient-practitioner confidentiality. Be particularly careful with images, and ensure that they do not reveal the identity of the patient. Images and illustrations that are taken from other sources must also be checked for copyright protection, and waivers should be signed if obtaining images that are copyright protected. Sources such as Creative Commons (creativecommons.org) may provide visual support without the need for copyright waivers.

Format

When formatting a case report, the structure should include an appropriate title, an abstract or introduction to the case, clear explanations of key terms in the text, and a concise clinical description of the patient. It should also provide a detailed overview of the procedure that was performed, a brief literature review of the key features of the case study, and a discussion of clinical and technical success or challenges of the procedure.

Title. The title should accurately reflect the overview of the article. Readers and researchers often use the article title or abstract to determine if an article is relevant to their research interests or practice.³ An inaccurate or vague title may mislead a reader, and hinder researchers from reviewing appropriate texts.

Abstract and Introduction. An abstract may be created as part of a case study. It should be a condensed summary of the article and include the key facts in the order that they are presented in the article. Case study abstracts should not exceed 150 words. After the abstract, keywords should be introduced. These are the words which allow researchers to find relevant topics using search engines such as ScienceDirect, PubMed, or Medline.⁴

An abstract is not necessary for Cath Lab Digest, but other journals may have this requirement (review the author guidelines).

Introduction. A brief introduction that overviews the article can be written instead of the abstract. An introduction consists of several concise sentences to describe the context of the case and summarize the entire article. It provides similar insight into the text as an abstract, and allows the limited word count of the article to be focused on the case study itself.

Case Presentation. This section should include an overview of the patient, case type, and historical context. If similar cases have been reported, describe them briefly, and also mention the reason why this case offers distinctive insights for practitioners.² This may include an unusual clinical presentation or a novel procedural indication. Once the background has been established, the clinical workup should be described.

The clinical workup should include the reasons for the patient interaction. This includes relevant history and physical assessment findings. This includes patient signs, symptoms, and physical complaints. It may also include noninvasive and invasive study results, vital signs, and critical laboratory values. The procedure, treatment or intervention that is going to be performed should be introduced at the end of this section. Relevant images, electrocardiogram findings, or illustrations may help support the presentation. This creates a smooth transition into the case description.

Case Description. The case description should discuss the patient treatment and initial post procedural outcome. This includes the access routes, technical steps of the procedure, technical challenges, and the end result of the procedure. Visual support is recommended to display new technologies and critical procedural steps. If this is a novel use of technology or approach, its role and purpose should be clearly explained. The measures and outcomes should include clinical and technical success or failure, and challenges that were navigated through during the procedure.

Post Procedure Discussion. After explaining the procedure or treatment, the post procedure discussion should be presented. This is the section that will demonstrate why the article is publishable. It should expand upon the introduction, focus on key issues, and explain why the case is noteworthy.^1,2 There should also be a concise literature review of the relevant factors of the case, such as efficacy of the treatment, measures and outcomes, and any relevant clinical trials. If this is a novel use of a product or technology, this section allows for a robust discussion of the use of the product or technology. The discussion also describes the existing theories and research findings on disease and its management.^2-4

Conclusion. A case report should end with a conclusion or overview of the case highlights. In this section, the author can give suggestions and recommendations for practice. The conclusion may be a brief, separate section of the article or it may be woven into the end of the discussion section.

When deciding to publish a case study, ask the following questions:

Relevance

• Is the case study appropriate for the journal?
• Does it validate or add to the body of knowledge in cardiovascular medicine?

Style

• Is the case organized, does it logically flow, and does it use appropriate headings?
• Does the technical writing avoid redundancy, have smooth transitions, and correct grammar?
• Dose the case report use appropriate and current medical terminology, and does it define acronyms that were used in the text?
• Does it include accurate and relevant figures and tables, images, and illustrations that support the text?
• Does the case study follow American Medical Association writing guidelines (the journal’s author guidelines will generally specify if this is the case)?⁵

References

• Are the references current, relevant, and scholarly?
• Do the references support the material presented?
• Are topics that are not common knowledge properly referenced and explained?⁵

Conclusion

The Cath Lab Digest editorial (review) board looks forward to supporting prospective writers. Case studies are an ideal way to make a contribution to the field because they are aligned to clinical practice and allow practitioners to share important clinical insights with professional peers. The editorial board and editorial staff will provide feedback, resources, and insights to turn prospective case studies into publishable manuscripts.

The case study, “Management of Submassive Pulmonary Embolism With Aspiration Thrombectomy,” has been designed to contribute to the field and offer an example of an effectively written case study. 

The authors can be contacted via Richard J. Merschen, EdS, RT(R)(CV), RCIS, at richard.merschen@pennmedicine.upenn.edu

References

1. CARE. Case report guidelines. 2013. Accessed May 4, 2022. https://www.care-statement.org/checklist

2. Guidelines to writing a clinical case report. Heart Views. 2017; 18(3): 104-105. doi:10.4103/1995-705X.217857

3. Stokes V, Fertleman C. Writing a case report in 10 steps. BMJ. 2015; 350: h2693. doi:10.1136/bmj.h2693

4. American College of Physicians. Writing a clinical vignette (case report) abstract. Accessed May 4, 2022. https://www.acponline.org/membership/residents/competitions-awards/acp-national-abstract-competitions/guide-to-preparing-for-the-abstract-competition/writing-a-clinical-vignette-case-report-abstract

5. Merschen RJ, Long BW. Writing with style. Radiologic Technol. 2016. Mar-Apr; 87(4): 468-471. PMID: 26952070.