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Case reports or correspondence?

An important function of medical journals is to publish cases that describe novel approaches to diagnosis or management, or provide warnings about potential hazards or complications. While publications of this type rank very low in the hierarchy of evidence-based medicine(1), they nevertheless provide a mechanism by which clinicians can share their experience, and thereby further promote patient safety.

Cases of this type may appear in two formats: formal 'Case Reports' or 'Letters to the Editor'. Over the last two years Anaesthesia and Intensive Care has published on average about six case reports per issue as well as several cases as letters to the Editor. This issue is not significantly different, with eight case reports, and three cases in the Correspondence section. What are the factors that determine the most appropriate format for publication and what are the various merits of each?

A full case report is necessary if a detailed description of the history, examination findings, special investigations and management are fundamental to the interpretation of the case. If a brief literature review is required to put the case into perspective, a full case report is also appropriate. However, often only one aspect of a case is of interest, and detailed descriptions of other aspects are irrelevant. These cases are published more appropriately as letters to the Editor.

Most authors prefer the case report format, in the belief that Case Reports carry more weight than correspondence in a list of publications. On the other hand, Letters to the Editor may be easier to prepare. Letters to the Editor are also more likely to result in earlier publication, because unlike Case Reports, they rarely require external peer review. Early publication may be important if a particular hazard or warning is being described.

The editorial policies of the journal will also influence the format of publication. The publication of Case Reports may adversely affect a journal's Impact Factor(3). This factor relates the number of articles published by a journal (denominator) to the number of citations these articles receive in an index year (numerator). Case Reports are included in the denominator but are rarely cited, so have little effect on the numerator(4, 5). In contrast, items of Correspondence are not included in the denominator. Therefore, if a journal is sensitive to its Impact Factor, it will tend to publish fewer Case Reports. The policy of Anaesthesia and Intensive Care is to publish case reports and Letters to the Editor on their merits.

In order for any 'case' to be accepted for publication, whether as a Case Report or as a Letter to the Editor, it must have clear educational value. Rarity or novelty alone, or descriptions of a job well done, are insufficient criteria for publication. Using the description of a case as a platform to express a personal opinion outside the boundaries of the case is also unacceptable. Extensive literature reviews are best submitted separately. Cases in which the message is ambiguous, or that do not comply with an accepted standard of care are not published. If there is any possibility that the patient involved can be identified, patient consent is now mandatory.

Anaesthesia and Intensive Care recognises the value of Case Reports and Correspondence to clinical anaesthetists, intensivists and pain medicine specialists, and welcomes submissions in both formats. Occasionally, authors will be invited to resubmit a brief version of a case report as a Letter to the Editor. This decision is usually based solely on whether the educational message of the case can be conveyed adequately in the shorter format. Both formats are indexed, so both are an effective means of disseminating information.


Associate Editor


(1.) Oxford centre for evidence based medicine levels of evidence accessed December 1, 2005.

(2.) Dearlove O, Vashist R. The value of case reports. Anaesthesia 2001; 56:690691.

(3.) Kam P. Impact factor: Overrated and misused? Anaesth Intensive Care 2005; 33:565566.

(4.) Patsopoulos NA, Anatolos AA, Ioannidis JP. Relative citation impact of various study designs in the health sciences. JAMA 2005; 293:23622366.

(5.) De Amici D, Carra C, Ceriana P, Gabutti G, Ramajoli F. Care reports in anaesthesiology: their trend through 17 years. Acta Anaesthesiologica Belgica 2000; 51:4350.
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Title Annotation:Editorial
Author:Gibbs, N.M.
Publication:Anaesthesia and Intensive Care
Date:Feb 1, 2006
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