Evaluation of the Quality of Case Reports from the Journal of Korean Medicine Based on the CARE Guidelines

Article information

J Korean Med. 2020;41(2):122-136
Publication date (electronic) : 2020 June 1
doi : https://doi.org/10.13048/jkm.20019
College of Korean Medicine, Gachon University
Correspondence to: Sung Youl Choi, 1342 Seongnam-Daero, Sujung-Gu, Seongnam 13120, South Korea, Tel: +82-32-770-1343, E-mail: pc1075@gachon.ac.kr
Received 2020 May 22; Revised 2020 May 27; Accepted 2020 May 28.

Abstract

Objectives

A case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. The purpose of this study is to evaluate the quality of case reports from the Journal of Korean Medicine by the CARE (CAse REport) Guideline.

Methods

Case reports published in the Journal of Korean Medicine from January 2016 to March 2020 were searched from Oriental Medicine Advanced Searching Integrated System (OASIS). We assessed the quality of reporting based on CARE (CAse REport) guideline as ‘Sufficient’, ‘Not-Sufficient’ and ‘Not-Report’.

Results

A total of 22 case reports were finally included for the assessment. The reporting items were reported as of reporting quality.

After checking the result, there was a deviation in the sub-item reporting rate by a maximum 89.29%, a minimum 66.67% and a median 82.14% in case reports.

Also after checking the quality in case reports by 28 detailed items in CARE guidelines, there were not reported 77% or more in the 5 sub-items ‘Intervention adherence and tolerability’, ‘Informed consent’, ‘Adverse and unanticipated events’, ‘Diagnostic challenges’, ‘Patient perspective’.

Conclusion

There is a need to improve the quality of case reports in the journal of Korean Medicine based on various studies using CARE guideline.

Fig. 1

Flow chart of case reports identified, screening, included process

Fig. 2

Case reports according to the quality of reporting evaluated by each item of CARE guideline

Percentage of Items Recording according to CARE Guide by Each Case Report

Percentage of Case Reports with Reporting Items of CARE Guide by Each Item

Acknowledgements

This study was supported by the 2016 Gachon University research fund (GCU-2016-0494).

References

1. Jenicek Milos. Clinical case reporting in evidence-based medicine p. 7–9. Guechuk Munwhasa; 2002.
2. Sackett David L, Rosenberg William MC, Muir Gray JA, Brian Haynes R, Scott Richardson W. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312(7023):71–2.
3. “Case reports” search results Bethesda, MD: PubMed, US National Library of Medicine; 2013. Availableat. http://www.ncbi.nlm.nih.gov/pubmed/?term=case+reports . Accessed June 10, 2013.
4. Kaszkin–Bettag M, Hildebrandt W. Case report on cancer therapies: the urgent need to improve the reporting quality. Glob Adv Health Med 2012;1(2):8–10.
5. Kljakovic M. Single cases in general practice and general medical journals. Aust Fam Physician 2002;31(7):669–73.
6. Schulz KF, Altman DG, Moher D. 2010;CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. BMJ 340:698–702.
7. STROBE Group. The 2009 STROBE Statement: Strengthening the reporting of observational studies in epidemiology Retrieved from www.strobe-statement.org .
8. Shamseer L, Moher D, Clarke M, et al. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (Prisma-P) 2015: Elaboration and Explanation. Bmj 2015;350:g7647.
9. Lee SM, Shin YS, Nam DW, Choi DY. Korean translation of the CARE guidelines. The Acupuncture 2015;32(4):1–9.
10. Kim JJ, Eom YJ, Lee YS, Nam DW, Chae YB. The Current Status of Quality of Reporting in Acupuncture Treatment Case Reports: An Analysis of the Core Journal in Korea. Evidence-Based Complementary and Alternative Medicine 2017;Article ID 5810372.
11. Lee HL, Kim JH, Lee MS, Lee JA. Evaluation of the quality of the case reports from the journal of pediatrics of Korean medicine based on the CARE guidelines. J Pediatr Korean Med 2018;32(3):131–40.
12. Kim JH, Lee HL, Lee JA, Lee MS. Assessment of the quality of reporting in case reports in journal of sasang constitutional medicine from year 2015 to 2018: using CARE guidelines. J Sasang Constitut Med 2018;30(2):28–41.
13. Park KM, Choi SY, Lee JA, Song YK. Evaluation of the quality of case reports of the journal of Korean medicine for obesity research from 2013 to 2018 according to the CARE (CAse REport) guidelines. Journal of Korean Medicine for Obesity Research 2018;18(2):144–51.
14. Lee HS, Lee JY, Han JH, Chae H. Evaluation of the Quality of Case Reports in Journal of Oriental Neuropsychiatry Using CARES Guideline. Journal of neuropsychiatry 2019;30(2):59–69.
15. Nam EY, Park JY. Evaluation of the Quality of the Case Reports from the Journal of Obstetrics and Gynecology of Korean Medicine Based on the CARE Guidelines. J Korean Obstet Gynecol 2019;32(2):71–86.
16. Ahn JH, Ko JH, Kim SY, Kim SJ, Bae JH, Yoon YJ, Lee HS, Chang HK, Kim HS, Chung SH, Lee JS, Kim SS, Chung WS. Evaluation of Adherence to the CARE (CAse REport) Guidelines of Case Reports in the Journal of Korean Medicine Rehabilitation. Journal of Korean Medicine Rehabilitation 2019;29(3):75–85.
17. Riley DS, Barber MS, Kienle GS, et al. Care Guidelines for Case Reports: Explanation and Elaboration Document. J Clin Epidemiol 2017;89:218–35.
18. Baik TH. A Case Study on A Patient with Non-Alcoholic Fatty Liver Disease (NAFLD) by Using Ultrasound. J Korean Med 2016;37(1):151–157.
19. Yang JE, Lee KH, Chang GT. Treatment of Psoriasis with Qi Deficiency: Two Cases Report. J Korean Med 2016;37(1):158–168.
20. Son CG. A Severe Hepatotoxicity by Antituberculosis Drug, and its Recovery in Oriental Hospital. J Korean Med 2016;37(2):119–124.
21. Jeon HJ, Park SR, Lee SK. Improvement of Chronic Bleeding in the Patient with Unresectable Advanced Gastric Cancer Using the Decoction of - a Case Report. J Korean Med 2016;37(2):104–109.
22. Yang JE, Lee KH, Chang GT. Treatment of Psoriasis with Exudation: Three Case Studies. J Korean Med 2016;37(2):110–118.
23. Cha JY, Heo JW, Yoo HR, Kim YS, Seol IC, Jo HK. A Case of Combined Korean-Western Medicine Treatment on Chorea Hyperglycemia Basal Ganglia Syndrome Induced by Nonketotic Diabetes Mellitus. J Korean Med 2016;37(3):131–138.
24. Yang JO, Lee HY, Yun YJ. Three Cases of Oral Mucoceles Treated with Traditional Korean Medicine. J Korean Med 2016;37(3):123–130.
25. Na HJ, Chang SG. A Diagnostic Imaging Case of Cervical Spinal Subluxation for Chuna Mannual Therapy: Cervical Malposition with OPLL. J Korean Med 2016;37(4):45–48.
26. Son CG. Case Report for a Refractory Levator Ani Syndrome Treated with Traditional Korean Medication. J Korean Med 2017;38(2):73–77.
27. Song SY, Jeon HJ, Lee SK. Improvement of Pneumonia in a Patient with Non-Small Cell Lung Cancer Treated with Herbal Medicine after Cessation of Antibiotics – a Case Report. J Korean Med 2017;38(2):78–84.
28. Choi JW, Bae JM, Kim JK, Lee BR, Yang GY. Effectiveness of Combined Korean Medicine on Traumatic Spinal Cord Injury: A Case Report. J Korean Med 2017;38(4):110–117.
29. Yang JO, Yun YJ, Hong JW, Han CW, Kwon JN, Lee I, Park SH, Kim SY, Choi JY, Lee HY. Case Report on Long Term Survival of Glioblastoma Patient Treated with Integrative Medicine. J Korean Med 2018;39(1):75–85.
30. Jung MY, Yoo JE. A Case Report of Polycystic Ovary Syndrome Treated by Sajaehyangbu-hwan. J Korean Med 2018;39(3):101–109.
31. Ryu JY, Kim MJ, Lee KW, Cho HK, Yoo HR, Seol IC, Kim YS. Delayed Neuropsychiatric Sequalae with Reversible Quadriplegia after Carbon Monoxide Intoxication: A Case Report. J Korean Med 2018;39(3):73–80.
32. Lee ES, Woo HL, Park KS, Hwang DS, Lee CH, Jang JB, Lee JM. Two Case Report of Obesity with atopic dermatitis Treated with Hwangryunhaedoktang-gamibang. J Korean Med 2018;39(3):81–88.
33. Kim MK. A case report of a patient with spinal cord infarction treated by Korean medicine combined with conventional medicine: An evaluation using Korean Standard Classification of Functioning, Disability and Health (KCF). J Korean Med 2018;39(3):89–100.
34. Lee SH, Joo JH, Chon SH. Successful Outcome of an Elderly Patient with Small Cell Lung Cancer with only Alternative Treatments: A Case Report. J Korean Med 2018;39(4):171–176.
35. Lee SH, Sohn KC, Chon SH. Successful Outcome of Breast Cancer Patient Refusing Conventional Treatments: A Case Report. J Korean Med 2018;39(4):177–182.
36. Geum JH, Baek DG, Lee JH. A Rehabilitation protocol for Arthroscopic Bankart repair in Korean Medicine: A Case Report. J Korean Med 2019;40(3):177–187.
37. Shin JM, Ahn JH, Lee JH. The Effect of Korean Medical Treatments for Facial asymmetry Patients: Five Cases Report. J Korean Med 2019;40(3):198–223.
38. Kim SK, Son CG, Choi IW, Park SJ. A case of Advanced Gastric cancer patient treated by Korean Medicine monotherapy. J Korean Med 2019;40(4):91–100.
39. Lee SH, Lee JH, Hong MA, Yun YJ, Park SH. A Case Report of Chronic Prostatitis/Chronic Pelvic Pain Syndrome(CP/CPPS) treated with Gyejibokryeong-hwan. J Korean Med 2020;41(1):117–125.
40. Li YR, Jia Z, Zhu H. Understanding the value of case reports and studies in the contest of clinical research, research design and evidence -based practice. J Case Reports and Studies 2013;1(2):1–4.

Article information Continued

Fig. 1

Flow chart of case reports identified, screening, included process

Fig. 2

Case reports according to the quality of reporting evaluated by each item of CARE guideline

Table 1

Percentage of Items Recording according to CARE Guide by Each Case Report

Case Reports Reporting Not-Report
Sufficient Not-Sufficient
1st author (year) n1/N % n2/N % (n1+n2)/N % n3/N %
Baik TH18) (2016) 18/28 64.29% 7/28 25.00% 25/28 89.29% 3/28 10.71%
Yang JE19) (2016) 18/28 64.29% 7/28 25.00% 25/28 89.29% 3/28 10.71%
Son CG20) (2016) 12/28 42.86% 10/28 35.71% 22/28 78.57% 6/28 21.43%
Jeon HJ21) (2016) 18/28 64.29% 7/28 25.00% 25/28 89.29% 3/28 10.71%
Yang JE22) (2016) 16/28 57.14% 7/28 25.00% 23/28 82.14% 5/28 17.86%
Cha JY23) (2016) 18/28 64.29% 5/28 17.86% 23/28 82.14% 5/28 17.86%
Yang JO24) (2016) 17/28 60.71% 7/28 25.00% 24/28 85.71% 4/28 14.29%
Na HJ25) (2016) 5/27 18.52% 13/27 48.15% 18/27 66.67% 9/27 33.33%
Son CG26) (2017) 18/28 64.29% 4/28 14.29% 22/28 78.57% 6/28 21.43%
Song SY27) (2017) 18/28 64.29% 5/28 17.86% 23/28 82.14% 5/28 17.86%
Choi JW28) (2017) 19/28 67.86% 3/28 10.71% 22/28 78.57% 6/28 21.43%
Yang JO29) (2018) 18/28 64.29% 6/28 21.43% 24/28 85.71% 4/28 14.29%
Jung MY30) (2018) 17/28 60.71% 6/28 21.43% 23/28 82.14% 5/28 17.86%
Ryu JY31) (2018) 17/28 60.71% 6/28 21.43% 23/28 82.14% 5/28 17.86%
Lee ES32) (2018) 20/28 71.43% 3/28 10.71% 23/28 82.14% 5/28 17.86%
Kim MK33) (2018) 19/28 67.86% 4/28 14.29% 23/28 82.14% 5/28 17.86%
Lee SH (1)34) (2018) 23/28 82.14% 2/28 7.14% 25/28 89.29% 3/28 10.71%
Lee SH (2)35) (2018) 17/28 60.71% 6/28 21.43% 23/28 82.14% 5/28 17.86%
Geum JH36) (2019) 18/28 64.29% 5/28 17.86% 23/28 82.14% 5/28 17.86%
Shin JM37) (2019) 13/28 46.43% 8/28 28.57% 21/28 75.00% 7/28 25.00%
Kim SK38) (2019) 14/28 50.00% 10/28 35.71% 24/28 85.71% 4/28 14.29%
Lee SH39) (2020) 16/28 57.14% 5/28 17.86% 21/28 75.00% 7/28 25.00%
Max. of % 82.14 48.15 89.29 33.33
Min. of % 18.52 7.14 66.67 10.71
Median of % 64.29 21.43 82.14 17.86

1) ‘n1’, ‘n2’, and ‘n3’ mean the number of which items match each assessment-criteria: Sufficient, Not-Sufficient and Not-Report, respectively.

2) ‘N’ means the number of applicable item.

Table 2

Percentage of Case Reports with Reporting Items of CARE Guide by Each Item

Topic Item no. Item description Sufficient Not-Sufficient Not-Report
n/N % n/N % n/N %
Title 1 The words “case report” (or “case sutdy”) should be in the title along with phenomenon of greatest interest (such as symptom, diagnosis, test, intervention) 17/22 77.27 4/22 18.18 1/22 4.55
Key Word 2 The key elements of this case in 2 to 5 words. 20/22 90.91 2/22 9.09 - -
Abstract 3a Introduction-What does this case add?
What is unique about this case?
17/22 77.27 5/22 22.73 - -
3b Case presentation:
  • - The main symptoms of the patient

  • - The main clinical findings

  • - The main diagnoses and interventions

  • - The main outcomes

4/22 18.18 18/22 81.82* - -
3c Conclusion-What are the main “take-away” lessons from this case? 16/22 72.73 6/22 27.27 - -
Introduction 4 Brief background summary of the case referencing the relevant medical literature. 21/22 95.45 1/22 4.55 - -
Patient Information 5a Demographic information of the patient (age, gender, ethnicity, occupation) 3/22 13.64 19/22 86.36* - -
5b Main symptoms of the patient (his or her chief complaints) 21/22 95.45 1/22 4.55 - -
5c Medical, family, and psychosocial history-including diet, life style and genetic information whenever possible and details about relevant comorbidities and past interventions and their outcomes 5/22 22.73 16/22 72.73* 1/22 4.55
Clinical findings 6 Describe the relevant physical examination (PE) and other significant clinical findings. 19/22 86.36 3/22 13.64 - -
Timeline 7 Depict Important dates and times in the case (table or figure) 16/22 72.73 6/22 27.27 - -
Diagnostic Assessment 8a Diagnostic methods (such as PE, laboratory testing, imaging, questionnaires) 18/22 81.82 4/22 18.18 - -
8b Diagnostic challenges (such as financial or language/cultural) - - 5/22 22.73 17/22 77.27*
8c Diagnostic reasoning including other diagnoses considered 9/22 40.91 7/22 31.82 6/22 27.27
8d Prognostic characteristics (such as staging in oncology) where applicable 19/22 86.36 3/22 13.64 - -
Therapeutic interventions 9a Types of intervention (such as pharmacologic, surgical, preventive, self-care) 22/22 100.00 - - - -
9b Administration of intervention (such as dosage, strength, duration) 14/22 63.64 7/22 31.82 1/22 4.55
9c Changes in intervention (with rationale) 6/22 27.27 10/22 45.45 6/22 27.27
Follow-up and outcomes 10a Clinician and patient-assessed outcomes (when appropriate) 18/22 81.82 3/22 13.64 1/22 4.55
10b Important follow-up diagnostic evaluations and other test results (positive or negative) 20/22 90.91 2/22 9.09 - -
10c Intervention adherence and tolerability (and how this was assessed) - - 1/21 4.76 20/21 95.24*
10d Adverse and unanticipated events 2/22 9.09 2/22 9.09 18/22 81.82*
Discussion 11a Strengths and limitations of the management of this case-with references 21/22 95.45 1/22 4.55 - -
11b Relevant medical literature 21/22 95.45 - 0.00 1/22 4.55
11c Rationale for conclusions (including assessment of cause and effect) 20/22 90.91 2/22 9.09 - -
11d Main “take-away” lessons of this case report 19/22 86.36 2/22 9.09 1/22 4.55
Patient perspective 12 The patient should share their perspective or experience whenever possible. - - 5/22 22.73 17/22 77.27*
Informed consent 13 Did the patient give informed consent?
Please provide if requested.
1/22 4.55 1/22 4.55 20/22 90.91*

1) ‘n’ means the number of which case reports match each assessment criteria of items: Sufficient, Not-Sufficient, Not-Report, respectively.

2) ‘N’ means that the number of case reports having applicable item.

3) ‘*’ means that the percentage of not-, or not-sufficiently reporting item more than 50%