The CARE reporting guideline for writing clinical case report articles

CARE: CAse REport

Reporting guidelines are recommendations to help write up research clearly.

Your research will be used by people from different disciplines and backgrounds for decades to come. Reporting guidelines are community-created recommendations for describing what you did and what you found so that everyone can understand, repeat, apply, and synthesise your work. Although they recommend information to include in your manuscript, they don’t dictate how to order that information.

Most reporting guidelines consist of the full guidance (sometimes called an Explanation and Elaboration document) and a checklist. The full guidance provides detailed explanations and examples for each item, and the checklist allows you to demonstrate adherence to editors.

You can use reporting guidelines throughout your research process. However you use reporting guidelines, please cite them.

Writing manuscripts

Write confidently using a reporting guideline to quickly turn a blank page into a thorough and impactful manuscript.

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Checking

Use a reporting checklist to demonstrate to an editor or peer reviewer that you have included everything. Many journals require completed checklists at submission.

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Writing applications

Reporting guidelines can help you write funding applications, ethics applications, and protocols, but they won’t make design decisions for you!

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Reporting guidelines are neither design nor quality appraisal tools.

Although reporting guidelines recommend information to include when writing up research, they do not mandate how to design research. Similarly, when reviewing literature, although you can use reporting guidelines to assess whether a manuscript is well reported, you cannot use them to appraise whether that study is well designed.

Full Guidance

Applicability Criteria

Checklist ⤓

Citation

Version: CARE 2013 v1.1. This website shows the latest version of CARE, first published in 2013, and updated here for usability.

Journals endorsing CARE: 400+

Applicability criteria

Commonly used reporting guidelines

STROBE Observational Studies
PRISMA Systematic reviews of trials
PRISMA-P Systematic review protocols
CONSORT Randomised trials
SPIRIT Randomised trial protocols
SRQR Qualitative Research
CARE Case Reports
STARD Diagnostic studies
TRIPOD+AI Prediction Models
ARRIVE Animal Research
SQUIRE Quality Improvement
CHEERS Economic Evaluations
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Use CARE for writing case reports, i.e., for describing a medical problem experienced by one or more patients for medical, scientific or educational purposes.

You can also use CARE for:

  • writing a fictional clinical case study for educational purposes,
  • reviewing the reporting of a case report, but not for appraising its quality

Do not use CARE for:

  • writing an article about surgical cases, use SCARE instead.

Summary of guidance

Although you should describe all items below, you can decide how to order and prioritize items most relevant to your study, findings, context, and readership whilst keeping your writing concise. You can read how CARE was developed in the FAQs.

Item name What to write
 Sections
1. Title The area of focus and “case report” should appear in the title.
2. Keywords The key elements of this case in 2–5 words.
3. Abstract

3a – Introduction: What does this case add?

3b – Case presentation:

  • The main symptoms of the patient(s).
  • The main clinical findings.
  • The main diagnoses and interventions.
  • The main outcomes.

3c – Conclusion: What are the main “take-away” lessons from this case?
4. Introduction Brief background summary of the case referencing the relevant medical literature.
5a. Patient information

5a – Demographic information of the patient (age, gender, ethnicity, occupation).

5b – Main symptoms of the patient (chief complaint).

5c – Medical, family, and psychosocial history—including lifestyle and genetic information whenever possible, details about relevant comorbidities, and past interv…
6. Clinical findings Describe the relevant physical examination (PE) findings.
7. Timeline Depict important date and times in this case (table or figure).
8. Diagnostic assessment

8a – Diagnostic methods (e.g., physical examination, laboratory testing, imaging, questionnaires)

8b – Diagnostic challenges (e.g., financial, language, or cultural)

8c – Diagnostic reasoning including other diagnoses considered

8d – Prognostic characteristics (e.g., staging) where applicable.
9. Therapeutic Intervention

9a – Types of intervention (e.g., pharmacologic, surgical, preventive, self-care)

9b – Administration (e.g., dosage, strength, duration)

9c – Changes in intervention (with rationale).
10. Follow up and outcomes

10a – Clinician and patient-assessed outcomes

10b – Important follow-up test results (positive and negative)

10c – Intervention adherence and tolerability (and how this was assessed)

10d – Adverse and unanticipated events.
11. Discussion

Discussion (including conclusion):

11a – Strengths and limitations of the management of this case

11b – Relevant medical literature

11c – Rationale for conclusions (including assessment of cause and effect)

11d – Main “take-away” lessons of this case report.
12. Patient perspective When appropriate patients should share their perspectives on the treatments they received.
13. Informed consent Did the patient give informed consent? Please provide if requested.

Training and Support

The UK EQUATOR Centre runs training on how to write using reporting guidelines.

Reuse

Most of the reporting guidelines and checklists on this website were originally published under permissive licenses that allowed their reuse. Some were published with propriety licenses, where copyright is held by the publisher and/or original authors. The original content of the reporting checklists and explanation pages on this website were drawn from these publications with knowledge and permission from the reporting guideline authors, and subsequently revised in response to feedback and evidence from research as part of an ongoing scholarly dialogue about how best to disseminate reporting guidance. The UK EQUATOR Centre makes no copyright claims over reporting guideline content. Our use of copyrighted content on this website falls under fair use guidelines.

Citation

For attribution, please cite this work as:
Gagnier JJ, Kienle G, Altman DG, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. Case Reports. 2013;2013:bcr2013201554. doi:10.1136/bcr-2013-201554

Reporting Guidelines are recommendations to help describe your work clearly

Your research will be used by people from different disciplines and backgrounds for decades to come. Reporting guidelines list the information you should describe so that everyone can understand, replicate, and synthesise your work.

Reporting guidelines do not prescribe how research should be designed or conducted. Rather, they help authors transparently describe what they did, why they did it, and what they found.

Reporting guidelines make writing research easier, and transparent research leads to better patient outcomes.

Easier writing

Following guidance makes writing easier and quicker.

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Smoother publishing

Many journals require completed reporting checklists at submission.

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Maximum impact

From nobel prizes to null results, articles have more impact when everyone can use them.

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Who reads research?

You work will be read by different people, for different reasons, around the world, and for decades to come. Reporting guidelines help you consider all of your potential audiences. For example, your research may be read by researchers from different fields, by clinicians, patients, evidence synthesisers, peer reviewers, or editors. Your readers will need information to understand, to replicate, apply, appraise, synthesise, and use your work.

Cohort studies

A cohort study is an observational study in which a group of people with a particular exposure (e.g. a putative risk factor or protective factor) and a group of people without this exposure are followed over time. The outcomes of the people in the exposed group are compared to the outcomes of the people in the unexposed group to see if the exposure is associated with particular outcomes (e.g. getting cancer or length of life).

Source.

Case-control studies

A case-control study is a research method used in healthcare to investigate potential risk factors for a specific disease. It involves comparing individuals who have been diagnosed with the disease (cases) to those who have not (controls). By analysing the differences between the two groups, researchers can identify factors that may contribute to the development of the disease.

An example would be when researchers conducted a case-control study examining whether exposure to diesel exhaust particles increases the risk of respiratory disease in underground miners. Cases included miners diagnosed with respiratory disease, while controls were miners without respiratory disease. Participants' past occupational exposures to diesel exhaust particles were evaluated to compare exposure rates between cases and controls.

Source.

Cross-sectional studies

A cross-sectional study (also sometimes called a "cross-sectional survey") serves as an observational tool, where researchers capture data from a cohort of participants at a singular point. This approach provides a 'snapshot'— a brief glimpse into the characteristics or outcomes prevalent within a designated population at that precise point in time. The primary aim here is not to track changes or developments over an extended period but to assess and quantify the current situation regarding specific variables or conditions. Such a methodology is instrumental in identifying patterns or correlations among various factors within the population, providing a basis for further, more detailed investigation.

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Systematic reviews

A systematic review is a comprehensive approach designed to identify, evaluate, and synthesise all available evidence relevant to a specific research question. In essence, it collects all possible studies related to a given topic and design, and reviews and analyses their results.

The process involves a highly sensitive search strategy to ensure that as much pertinent information as possible is gathered. Once collected, this evidence is often critically appraised to assess its quality and relevance, ensuring that conclusions drawn are based on robust data. Systematic reviews often involve defining inclusion and exclusion criteria, which help to focus the analysis on the most relevant studies, ultimately synthesising the findings into a coherent narrative or statistical synthesis. Some systematic reviews will include a [meta-analysis]{.defined data-bs-toggle="offcanvas" href="#glossaryItemmeta_analyses" aria-controls="offcanvasExample" role="button"}.

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Systematic review protocols

TODO

Meta analyses of Observational Studies

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Randomised Trials

A randomised controlled trial (RCT) is a trial in which participants are randomly assigned to one of two or more groups: the experimental group or groups receive the intervention or interventions being tested; the comparison group (control group) receive usual care or no treatment or a placebo. The groups are then followed up to see if there are any differences between the results. This helps in assessing the effectiveness of the intervention.

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Randomised Trial Protocols

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Qualitative research

Research that aims to gather and analyse non-numerical (descriptive) data in order to gain an understanding of individuals' social reality, including understanding their attitudes, beliefs, and motivation. This type of research typically involves in-depth interviews, focus groups, or field observations in order to collect data that is rich in detail and context. Qualitative research is often used to explore complex phenomena or to gain insight into people's experiences and perspectives on a particular topic. It is particularly useful when researchers want to understand the meaning that people attach to their experiences or when they want to uncover the underlying reasons for people's behaviour. Qualitative methods include ethnography, grounded theory, discourse analysis, and interpretative phenomenological analysis.

Source

Case Reports

TODO

Diagnostic Test Accuracy Studies

Diagnostic accuracy studies focus on estimating the ability of the test(s) to correctly identify people with a predefined target condition, or the condition of interest (sensitivity) as well as to clearly identify those without the condition (specificity).

Prediction Models

Prediction model research is used to test the accurarcy of a model or test in estimating an outcome value or risk. Most models estimate the probability of the presence of a particular health condition (diagnostic) or whether a particular outcome will occur in the future (prognostic). Prediction models are used to support clinical decision making, such as whether to refer patients for further testing, monitor disease deterioration or treatment effects, or initiate treatment or lifestyle changes. Examples of well known prediction models include EuroSCORE II for cardiac surgery, the Gail model for breast cancer, the Framingham risk score for cardiovascular disease, IMPACT for traumatic brain injury, and FRAX for osteoporotic and hip fractures.

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Animal Research

TODO

Quality Improvement in Healthcare

Quality improvement research is about finding out how to improve and make changes in the most effective way. It is about systematically and rigourously exploring "what works" to improve quality in healthcare and the best ways to measure and disseminate this to ensure positive change. Most quality improvement effectiveness research is conducted in hospital settings, is focused on multiple quality improvement interventions, and uses process measures as outcomes. There is a great deal of variation in the research designs used to examine quality improvement effectiveness.

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Economic Evaluations in Healthcare

TODO

Meta Analyses

A meta-analysis is a statistical technique that amalgamates data from multiple studies to yield a single estimate of the effect size. This approach enhances precision and offers a more comprehensive understanding by integrating quantitative findings. Central to a meta-analysis is the evaluation of heterogeneity, which examines variations in study outcomes to ensure that differences in populations, interventions, or methodologies do not skew results. Techniques such as meta-regression or subgroup analysis are frequently employed to explore how various factors might influence the outcomes. This method is particularly effective when aiming to quantify the effect size, odds ratio, or risk ratio, providing a clearer numerical estimate that can significantly inform clinical or policy decisions.

How Meta-analyses and Systematic Reviews Work Together

Systematic reviews and meta-analyses function together, each complementing the other to provide a more robust understanding of research evidence. A systematic review meticulously gathers and evaluates all pertinent studies, establishing a solid foundation of qualitative and quantitative data. Within this framework, if the collected data exhibit sufficient homogeneity, a meta-analysis can be performed. This statistical synthesis allows for the integration of quantitative results from individual studies, producing a unified estimate of effect size. Techniques such as meta-regression or subgroup analysis may further refine these findings, elucidating how different variables impact the overall outcome. By combining these methodologies, researchers can achieve both a comprehensive narrative synthesis and a precise quantitative measure, enhancing the reliability and applicability of their conclusions. This integrated approach ensures that the findings are not only well-rounded but also statistically robust, providing greater confidence in the evidence base.

Why Don't All Systematic Reviews Use a Meta-Analysis?

Systematic reviews do not always have meta-analyses, due to variations in the data. For a meta-analysis to be viable, the data from different studies must be sufficiently similar, or homogeneous, in terms of design, population, and interventions. When the data shows significant heterogeneity, meaning there are considerable differences among the studies, combining them could lead to skewed or misleading conclusions. Furthermore, the quality of the included studies is critical; if the studies are of low methodological quality, merging their results could obscure true effects rather than explain them.

Protocol

A plan or set of steps that defines how something will be done. Before carrying out a research study, for example, the research protocol sets out what question is to be answered and how information will be collected and analysed.

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