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1. An Academic presentation by
Dr. Nancy Agnes, Head, Technical Operations, Pubrica
Group: www.pubrica.com
Email: sales@pubrica.com
HOW MANY PATIENTS
DOES CASE SERIES
SHOULD HAVE
IN COMPARISON TO
CASE REPORTS

2. Today's Discussion
In-Brief
Introduction
When to Consider a Case Series
When High Acceptance Rate is Possible
Subjects in Case Series and Case Report
Merits and Demerits
Criteria
Conclusion
Outline

3. In-Brief
The medical research field is continuously expanding, with more amount of data,
being generated every day. In clinical research, several studies have been
classified into descriptive and analytic studies. Descriptive studies include cross-
sectional studies, ecological correlational studies, case reports writing, case series
report writing and surveillance studies. On the other hand, analytical studies
examine a hypothesis about a causal relationship between exposure and
outcome. Since the objective of this article is on case report and case series, the
analyses would be restricted only to those type of studies alone.

4. Introduction
A case series and case reports consist of either of
aggregate of individual cases in one publication on
the diagnosis and treatment or a report of a single
patient.
A high number of case reports been received for
publication, but it seems the rejection rate of CRs is
quite high across many journals.
This is because, according to the principle of
evidence-based medicine, they provide a lower
strength of evidence among clinical studies, as
shown in Figure 1.
Contd...

5. Out of two different forms of clinical research studies
– (i) descriptive and (ii) analytic, case series (CS)
and case reports (CR) fall under descriptive one.
In specific, case reports/series are usually
retrospective and occasionally be prospective, such
as the Herrick’s first case report of sickle cell
disease.
Contd...

7. When to
Consider a
Case Series
If you intend to publish your case reports and case
series, remember your reports should be the first
document medical breakthroughs i.e., reporting of rare
diseases in identifying adverse or beneficial outcomes of
intervention or novel diagnostic or therapeutic strategies.
Further, the primary purpose was to generate
hypotheses that can be subsequently tested in studies of
greater methodological rigour.
Contd...

8. Therefore, case series can be applied to assess the treatment safety and
diagnostic accuracy, and in fact, no control group is necessary with good long-term
follow-up.
In order to get your research to be funded, there is a need for preliminary evidence
on which to base the belief that a treatment may be efficacious.
In this case, these reports often provide the first level of evidence.
A study published in the Journal of Clinical Epidemiology examined the case
reports and case series published in The Lancet Journal.
Contd...

9. The study demonstrated that case series that are carefully designed and, of
course, similar to clinical trials are likely to minimize bias and maximize the
information that can be deduced from a limited number of patients.
Besides, in order to publish your reports, need to ensure that both case series
and reports have to follow a standard structure and methodological rigour with
reference to selection, ascertainment, casualty and reporting.
The following section highlights the difference between these two reports and
possible ways to get it published in High impact journals.

10. When High
Acceptance
Rate is
Possible
Difference between a case series and a case report
A case series in general carries information acquired
from various sources containing one or more information
about the disease, treatment, diagnostic methods, etc.,
whereas a case report contains a very less amount of
data and may contain in-depth demographical details.
It takes more time to accept the case series than the
time taken to accept the case report by any publisher.
Contd...

11. Case reports are professional narratives that offer feedback on clinical practice
guidelines and provides a framework for adverse events, initial signals of
effectiveness, and cost.
They can be shared for medical, scientific, or educational purposes.

12. Subjects in
Case Series
and Case
Report
Many publishers strongly stick to the count of the
patients reported in the study.
After the study reports, [1] suggested that a case report
contain patients of less than five individuals, whereas a
case series can contain four and more patients.
Few journals have no upper limit set for the case series;
other journals accept nearly 20 patients report as a
single case series.
Contd...

14. Merits and
Demerits Both case series and case report writing have their
merits and demerits.
Case series is very useful in rare case scenarios where
a new kind of disease or disorder harms the subject.
Also, the publishers may make few negotiations in
considering a case series due to the biased contents
based upon the editors' personal opinions.
Besides, case series has high external validity, no
interference in treatment decision process, wide range
of patients and finally inexpensive.
Contd...

15. In terms of limitations, the study lack of comparison
groups, data collection often be incomplete, susceptible
to bias, selection and measurement bias.
On the other hand, case reports help healthcare
professionals easily understand the cases and take less
time to be prepared.
But case reports may not possess all the relevant and
minute details to treat the subjects.
No randomisation is followed in a case series;
therefore, it becomes more efficient and affordable.

16. Criteria
Whenever a case series is getting developed, few
criteria need to be followed.
(i) Title – Remember to include the words “case series” and
the area of focus in the title
(ii) Abstract’ – Introduction - Unifying theme of the case
series should be emphasized
a. Methods – what was done, how and when.
b. Results – what was found.
c. Conclusion – what we have learned.
Contd...

17. (iii) Introduction – emphasize the scientific background
and rationale.
(iv) Design –the research registry number
(ResearchRegistry.com or ClinicalTrials.gov or
ISRCTN), list the intended population, process
manner, and end outcome.
There must be a proper method to acquire the data
like regular telephone calls, clinical observation, and
more.
Study design should be sated including prospective,
retrospective in design.
Contd...

18. Also, enough time should be given between continuous
follow-ups.
Not a case series would be attractive when taking the
subject cases that last more than a year because
increasing the period may lead to disruption of study in
the middle due to any unexpected situations like the
patient would die or relocate his/her place or change
the hospital.
(ii) Analysis – Descriptive statistics and methodologies
must be used while analysing and no comparative tests
yielding p values should be carried out.
Contd...

19. (iii) Reporting – A case series must report the subject
details and progress, complete details, and analyse
every follow-up.
There must be no declared conclusions at the end
because once a valid conclusion is declared, it makes
the investigators keep on updating the results by
comparing with other results, which develops a need
for hypothesis testing.
Contd...

20. The researcher must understand the limitations before
getting engaged and possess awareness about the
conclusions.
Pubrica has extensive experience in developing a
detailed clinical case report Writing Services that assist
in highlighting the scientific documentation.
Contd...

22. Conclusion
Both case series and case reports in the clinical
research field are meant to be utilized by healthcare
professionals.
Except for the distinguishing features between a case
series and a case report, they both tend to give valid
information with timely intervention.
Contd...

23. If both are well prepared from the initial stages, they
can even be alternatives to another level of studies
employed more confidently than the former.
Reporting case series in a standardized and
statistically appropriate manner would allow for proper
interpretation at the same time enable to conduct of
future meta-analyses to produce estimates for the
long-term outcomes.

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