臨床症例報告ジャーナル

Role and Evidence of Case Reports and Case Series in Primary Care: A Discussion Paper

Abstract

Schencking M, Sonnichsen A, Redaelli M and Vollmar HC

Clinical guidelines, defined as ‘systematically developed statements to assist both practitioner and patient decisions in specific circumstances, have become an increasingly familiar part of clinical care. A central challenge in Primary Care is the question of how do we act in the field of atypical courses of diseases or clinical symptoms beside the spectrum of EBM and how could this gap be measured in scientific literature. Main purpose of this paper is a brief analysis of the actual role and evidence of clinical case reports and case series in primary care as a basis for a scientific discussion. According to the scientific-accepted Oxford levels of evidence case reports and case series belong to the level 4 of evidence. At present a significant majority of published case reports deal with descriptions of physician’s care following their clinical intuition beside the pathways of randomized controlled trials (RCT) or guidelines. Clinical symptoms of many cases will add up to what we would recognize as a ‘medical’ condition, but in up to 19% they are vague, non-specific and/or contradictory and the management of patients with such undefined symptoms can pose a daunting challenge. Even randomized controlled trials are the gold standard in clinical research and systematic reviews and meta-analysis have the highest level of evidence, there is still a need for well-prepared case reports; for instance to describe rare adverse drug effects.