Evidence Based Case Report

Sylvia Rianissa Putri

30 November 2015
 Case Report
• Capturing an unusual or interesting disorder
• Publish or perish
• Valuable information
– A diagnostic or therapeutic dilemma or present
important information on an adverse reaction to
a particular form of treatment.
– Suggest the need for change in practice or
thinking in terms of diagnosis or prognosis.
 What is an EBCR?
• systematic and evidence-based approach to
case management
• describes a patient presentation in much the
same way as in a traditional case report
• articulates a structured clinical question in a
format that generates key terms that can be
used to search the research evidence base
 EBCR vs Traditional CR
• The search strategy is described so that the
reader can decide whether a comprehensive
search has been conducted, much in the
same way as for a systematic review
• Once the relevant evidence has been
identified and appraised, it is synthesised
together with the clinician’s experiential
knowledge to inform a management plan for
the patient.
 Case Report vs Case Series
• Difference:
– Collections of reports on the treatment of
individual patients (CS) or a report on a single
patient (CR).
• Similarity:
– No control groups with which to compare
outcomes, so limited statistical validity.
 How to Produce and Present an
EBCR
1. Define and describe the problem
2. Search for the evidence
3. Select the best evidence only
4. Present and write up your findings under
headings
 Defining and Describing the Problem

1. Ask:
a. What is the problem?
b. How common is it?
c. Why is it important?
d. Is the problem getting worse or better?
e. Is the issue one of causation, diagnosis, benefits or
harms of care, costs, coverage?
f. What is your perspective?
2. State the question(s) clearly
3. Restate the questions in useful/searchable
form
 Searching for the Evidence
• Decide on the very best study design(s) that
should be employed to answer your
question(s)
• Identify methods to find relevant articles
Selecting the Best Evidence Only

1. Employ explicit and reproducible criteria

for selecting the evidence
2. Abstract the evidence from the remaining
papers into the evidence table
3. Develop criteria for communicating the
strength of the findings of articles/reports
Presenting and Writing up Your Findings
under Headings
• Introduction
• (Summary of) case illustration
• Discussion:
– Reason for writing a CR on the particular pt chosen
– What the literature search revealed
– Proof for the rarity or uniqueness of a condition or
response to treatment
– Scientific explanations for the position you have
adopted concerning the management of this
particular case
Presenting and Writing up Your Findings
under Headings
– Describe the cause of a particular condition, why you
chose a particular clinical aspect of it and how this
influenced the outcome for the patient.
– What recommendations you would make for future
patients based on your experience if your approach
differed from a standard treatment approach
– What lessons can be learnt
• Conclusion
• References
• Acknowledgements
• Additional information
 Limitation of CR
• The management of patients in an out-patient
setting occurs primarily in an uncontrolled
environment  cannot be generalized beyond the
context of the patient reported
• Results of patient responses to care are also limited
by the natural history of the disorder under study
(spontaneous remission or phases of exacerbation
and remission)  if correspond with the time when
care is provided: could lead to a faulty conclusion.
• Patient identity may be compromised because of the
unique qualities of a case  consent to publish