Correspondence

Case reports describing treatments in the emergency medicine literature: missing and misleading information

Tiffany P Richason^{* 1} , Stephen M Paulson^{* 2} , Steven R Lowenstein³ and Kennon J Heard^3,4

¹University of Colorado School of Medicine, Aurora CO, USA

²Denver Health Residency in Emergency Medicine, Denver Health, Denver CO, USA

³The Colorado Emergency Medicine Research Center, Division of Emergency Medicine, Department of Surgery, University of Colorado School Denver of Medicine, Aurora CO, USA

⁴Rocky Mountain Poison and Drug Center, Denver Health, Denver CO, USA

author email corresponding author email* Contributed equally

BMC Emergency Medicine 2009, 9:10doi:10.1186/1471-227X-9-10

Published:	15 June 2009

Abstract

Background

Although randomized trials and systematic reviews provide the "best evidence" for guiding medical practice, many emergency medicine journals still publish case reports (CRs). The quality of the reporting in these publications has not been assessed.

Objectives

In this study we sought to determine the proportion of treatment-related case reports that adequately reported information about the patient, disease, interventions, co-interventions, outcomes and other critical information.

Methods

We identified CRs published in 4 emergency medicine journals in 2000–2005 and categorized them according to their purpose (disease description, overdose or adverse drug reactioin, diagnostic test or treatment effect). Treatment-related CRs were reviewed for the presence or absence of 11 reporting elements.

Results

All told, 1,316 CRs were identified; of these, 85 (6.5%; 95CI = 66, 84) were about medical or surgical treatments. Most contained adequate descriptions of the patient (99%; 95CI = 95, 100), the stage and severity of the patient's disease (88%; 95CI = 79, 93), the intervention (80%; 95CI = 70, 87) and the outcomes of treatment (90%; 95CI = 82, 95). Fewer CRs reported the patient's co-morbidities (45%; 95CI = 35, 56), concurrent medications (30%; 95CI = 21, 40) or co-interventions (57%; 95CI = 46, 67) or mentioned any possible treatment side-effects (33%; 95CI = 24, 44). Only 37% (95CI = 19, 38) discussed alternative explanations for favorable outcomes. Generalizability of treatment effects to other patients was mentioned in only 29% (95CI = 20, 39). Just 2 CRs (2.3%; 95CI = 1, 8) reported a 'denominator" (number of patients subjected to the same intervention, whether or not successful.

Conclusion

Treatment-related CRs in emergency medicine journals often omit critical details about treatments, co-interventions, outcomes, generalizability, causality and denominators. As a result, the information may be misleading to providers, and the clinical applications may be detrimental to patient care.