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Ideas and Opinions |20 February 2001

In Defense of Case Reports and Case Series

Jan P. Vandenbroucke, MD, PhD

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Author, Article, and Disclosure Information
  • From Leiden University Hospital Medical Center, Leiden, the Netherlands.

    Acknowledgment:The author thanks Iain Chalmers and Milos Jenicek for suggestions on an earlier draft and Micky Weingarten for providing one of the examples.

    Requests for Single Reprints:Jan P. Vandenbroucke, MD, PhD, Department of Clinical Epidemiology, Leiden University Hospital Medical Center, Box 9600, 2300 RC Leiden, the Netherlands; e-mail, vdbroucke@mail.medfac.leidenuniv.nl.

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Readers of the medical literature wonder whether they should still make time to read case reports and case series. How should they balance this time-honored cornerstone of the medical literature with the demands of modern evidence-based medicine? Case reports and case series have been subject to some serious questioning. It has been said that “more often than not,” new ideas from case reports are not sustained on further research, that case reports contain “misleading elements” in clinical presentation, and that they do “more harm than good” by emphasizing the bizarre (1).
Many clinicians will protest that relegating case reports and case series to second-class status in the medical literature means that babies are being thrown away with the bathwater. How can we make this concern explicit and rational? Basically, by emphasizing that all types of research have their proper place (2). Evidence-based medicine is exclusively concerned with finding the best evidence for clinical decisions; for example, should we apply a particular therapy or a diagnostic test to a particular patient? Hence, a hierarchy of evidence with the randomized trial “on top” serves one purpose admirably: the final evaluation of therapies or tests, especially when their clinical value is not immediately clear-cut. Case reports and case series, however, have other aims that are equally important in the progress of medical science and education (3). These aims are a necessary complement to the aims of evidence-based medicine.
A brief list of potential roles of case reports and case series...
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Vandenbroucke JP. In Defense of Case Reports and Case Series. Ann Intern Med. 2001;134:330–334. doi: 10.7326/0003-4819-134-4-200102200-00017

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Published: Ann Intern Med. 2001;134(4):330-334.

DOI: 10.7326/0003-4819-134-4-200102200-00017

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2001 American College of Physicians
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