Do we CARE about the quality of case reports? A systematic assessment

Clinical case reports are important sources of information on the identification and treatment of new or rare diseases. The CAse REport (CARE) Statement and Checklist represents consensus-based guidelines for clinical case reports. How well case reports adhere to these guidelines is unknown.

A systematic PubMed and OVID search was used to identify case reports on isolated splenic metastasis from 2007 to 2017 in English language journals. MeSH search terms included "(isolated splenic metastasis OR solitary splenic metastasis) AND case report." We retrieved 79 articles and 55 directly addressed the topic of interest. Each was scored dichotomously using the 13 categories with 36 item descriptors on the CARE checklist.

Of the 55 case reports, none fully followed the CARE guidelines; only 56.4% met 23 descriptors and none had more than 29 of 36 descriptors. Patient symptoms were not described in 40.0%, and in 47.3%, the abstract did not identify the main outcomes. All reports included patient's age and diagnostic methods. Most case reports reported the type of intervention (96.4%) and effect of the intervention (96.4%). None included patient-assessed outcomes or the patient's perspective. Only 49.1% included strengths and limitations of patient management, stating that the most effective treatment is unknown.

None of the case reports on isolated splenic metastasis completely followed the CARE guidelines. Most reports did cover diagnostic workup and therapeutic interventions and gave a summary of the literature. Higher quality case reports would be useful in facilitating recognition of rare disease processes and informing clinical practice.