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JKM > Volume 41(2); 2020 > Article
Choi: Evaluation of the Quality of Case Reports from the Journal of Korean Medicine Based on the CARE Guidelines

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.

ACKNOWLEDGMENTS

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

Fig. 1
Flow chart of case reports identified, screening, included process
jkm-41-2-122f1.gif
Fig. 2
Case reports according to the quality of reporting evaluated by each item of CARE guideline
jkm-41-2-122f2.gif
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%

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