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Editorial
Importance of case reports in anaesthesia
Importancia de los reportes de caso en anestesiología
David A. Rincón-Valenzuelaa,
Corresponding author
darinconv@unal.edu.co

Corresponding author: Ciudad Universitaria. Facultad de Medicina. Universidad Nacional de Colombia. Calle 45 N. 30- 03. Bogotá D. C., Colombia. Teléfono +57 1 3165000.
, Ricardo Navarro-Vargasb, Javier Eslava-Schmalbachc
a MD, MSc, Professor of Anaesthesia, Facultad de Medicina, Universidad Nacional de Colombia; Anaesthetist, Clínica Universitaria Colombia; Member of the Outcomes Research Consortium. Bogotá D.C., Colombia
b MD, Professor of Anaesthesia, Facultad de Medicina, Universidad Nacional de Colombia. Bogotá D.C., Colombia
c MD, MSc, PhD, Professor, Facultad de Medicina, Universidad Nacional de Colombia. Manager Centro de Desarrollo Tecnológico, Sociedad Colombiana de Anestesiología y Reanimación, S.C.A.R.E., Bogotá D.C., Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Definition</span><p id="par0005" class="elsevierStylePara elsevierViewall">A case &#40;from the Latin <span class="elsevierStyleItalic">casus&#41;</span> is defined as something that occurs &#40;occurrence&#41;&#44; an event or happening&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a> According to the dictionary of the Royal Spanish Academy&#44; to report is the action of conveying&#44; communicating or giving notice&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">2</span></a> Although the case could be assimilated to the individual or patient&#44; the term refers in fact to the disease or the clinical condition at hand&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a> Case reports present clinical observations in a form that is particular to healthcare-related sciences&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a> More specifically&#44; they are a formal summary of a patient and his&#47;her disease&#44; including the presence or absence of signs and symptoms&#44; diagnostic tests&#44; treatment and outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From the methodological point of view&#44; reports and case series may be considered observational and descriptive studies&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">5</span></a> Traditionally&#44; case reports and case series have been mixed indiscriminately in the literature&#46; Articles categorized as case series have been published with only one patient reported&#44; and case reports have been published with more than five patients described&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">6</span></a> Based on statistical&#44; epidemiological and clinical criteria&#44; five has been recently defined as the maximum number of patients that must be described in a case report&#59; consequently&#44; six or more patients described are considered a case series&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">History</span><p id="par0015" class="elsevierStylePara elsevierViewall">In the history of medicine&#44; case reports and case series have been an integral part of the biomedical literature&#46; Case reports date back to 1600 B&#46;C&#46;&#44; in ancient Egypt&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a> Similar narrative formats were found in Hippocratic manuscripts written circa 400 B&#46;C&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">9</span></a> Sir William Osler &#40;1849&#8211;1919&#41;&#44; considered the father of modern medicine&#44; believed that physicians had to keep detailed records of unusual situations in their clinical practice and make them public in a short and concise form&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our specialty&#44; the first case of general anaesthesia with ether in 1846 was documented in a case report published by Bigelow&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">10</span></a> Up to this date&#44; this case report may be considered as one of the most important in the history of medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">11</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes some salient case reports in the history of anaesthesiology&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Since the 1940s&#44; with the emergence of experimental designs followed by the idea and development of evidence-based medicine&#44; great emphasis has been placed on quantitative studies with large sample sizes&#46; Experimental trials are at the top of the hierarchy of clinical evidence&#44; while case reports are lower down in the same classification&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">22</span></a> On the other hand&#44; journals that publish studies with higher levels of evidence gain more prestige&#44; and these studies are cited a larger number of times&#44; giving a favourable shift to the impact factor&#46; Case reports are usually cited less compared to prospective observational studies and clinical trials&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">23</span></a> For a journal&#44; this means that publishing case reports might have a potentially deleterious effect on the impact factor&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">24</span></a> In the 1970s and 1980s&#44; this gave rise to the so-called marginalization of case reports&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; towards the end of the past century&#44; case reports gained new popularity in the biomedical literature&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">1</span></a> This phenomenon has been attributed mainly to three things&#44; among others&#46; First&#44; in the hierarchy of evidence-based medicine&#44; the single-case research methodology &#40;trials with an N of 1&#41; gained traction&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">25</span></a> Second&#44; in 1995&#44; the Lancet introduced a section on peer reviewed case reports limited to 600 words&#44; addressed mainly to physicians in training&#44; under the premise that this group of practitioners have a more intense clinical exposure in terms of the number of patients compared to their faculty&#44; and this may represent an important source of case reports&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">26</span></a> And third&#44; in 1998&#44; the BMJ &#40;originally the British Medical Journal&#41; introduced a new type of article&#44; i&#46;e&#46;&#44; evidence-based case report&#44; in order to improve reader skills in terms of the application of the clinical evidence&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Current situation of case reports</span><p id="par0035" class="elsevierStylePara elsevierViewall">Rarity by itself is no justification to report a case&#46; Reported cases must contribute to knowledge creation and must give rise to hypotheses and research questions to be solved in subsequent clinical research&#59; they must contribute to the information on known diseases&#44; and to their diagnosis or treatment&#59; and they must always accomplish a clear learning objective for the readers&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">28&#8211;30</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Up to this date&#44; the number of case reports published continues to grow&#44; and close to 1000 case reports &#40;2&#37;&#41; of the 50 thousand indexed in MEDLINE every year relate to anaesthesiology &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In the Colombian Journal of Anaesthesia &#40;<span class="elsevierStyleItalic">Revista Colombiana de Anestesiolog&#237;a</span>&#41;&#44; close to 25&#37; of all articles published are case reports&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">31</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Considering that biomedical journals find themselves at a cross-roads at the present time because they need to respond to the irrefutable importance and the need for case reports on the one hand&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">32</span></a> and strive to increase their own impact factor on the other&#44; editorial committees have defined more stringent criteria in terms of quality&#44; novelty&#44; exceptional interest&#44; brevity and relevance of a case report for publication&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">33</span></a> Indeed&#44; the recent CARE declaration &#40;from CAse REport&#41; stated the guidelines that must be followed by all manuscripts of this type&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Along these same lines&#44; clearly recognizing the importance of case reports in anaesthesia&#44; very prestigious journals have made the decision of transferring case reports<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">24&#44;34</span></a> from their core publications to new journals exclusively devoted to case reports&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">35</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Consistent with all of the above&#44; the Colombian Journal of Anaesthesia recently adhered to the CARE declaration guidelines in order to move towards the standardized format in which case reports are published&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">36</span></a> Moreover&#44; as proof of the journal&#39;s commitment regarding the importance of case reports as a valid strategy for scientific dissemination&#44; this issue includes six case reports<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">37&#8211;41</span></a> and one case series&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">42</span></a> They were all subjected to a peer review process&#44; they adhere most certainly to modern writing standards&#44; and they will contribute to the education objectives that readers expect from these types of primary studies&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None known&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rinc&#243;n-Valenzuela DA&#44; Navarro-Vargas R&#44; Eslava-Schmalbach J&#46; Importancia de los reportes de caso en anestesiolog&#237;a&#46; Rev Colomb Anestesiol&#46; 2016&#59;44&#58;1&#8211;4&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reason for the report&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1846 Bigelow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">First general anaesthesia with ether &#40;Dr William Morton&#44; October 16&#44; 1846&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death attributable to general anaesthesia with chloroform in Hannah Greener&#44; a 15-year-old patient taken to a minor procedure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Effect of the intrathecal cocaine injection&#44; including the description of post dural puncture headache&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1975 Harrison&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful treatment of malignant hyperthermia with dantrolene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 22562087
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos