N. C. Dragnev1, S. L. Wong1 1Geisel School Of Medicine At Dartmouth,Surgery,Hanover, NH, USA
Introduction: Clinical case reports are important sources of information on the identification and treatment of new or rare diseases. Case reports are most useful when accurate, complete and transparent information are included. The CARE (CAse REport) Statement and Checklist represents consensus-based guidelines for clinical case reports. Despite adoption of CARE guidelines by the international EQUATOR Network, which represents medical journal editors, guideline developers, and other key stakeholders, how well case reports adhere to these guidelines is unknown.
Methods: A systematic PubMed and OVID search was used to identify case reports on isolated splenic metastasis from 2007-2017 in English language journals. MeSH search terms included “(isolated splenic metastasis OR solitary splenic metastasis) AND case report.” We retrieved 79 articles and 55 were found to directly address the topic of interest. Each eligible guideline was then scored using the 13 categories on the CARE checklist, which formally included 36 items ranging from the elements of presenting concerns to patient outcomes. Fulfillment of each item was rated on a dichotomous (yes/no) basis.
Results: Of the 55 case reports, none fully followed the CARE guidelines; only 56.4% of reports met 23 checklist items and none had more than 29 out of 36 total items (Figure). Only 35 of 55 (63.6%) case reports included the words “case report” in the title. In 22/55 (40.0%), patient symptoms were not described and in 26/55 (47.3%), the report’s abstract did not identify the main outcomes. All reports included the patient’s age and described the diagnostic work up. Most case reports reported the type of intervention (96.4%) and effect of the intervention (96.4%). Most also included a summary of the literature (49/55, 89.1%), but none included patient-assessed outcomes or the patient's perspective. In nearly all cases, a splenectomy was performed, followed by systemic chemotherapy. Only 27 reports (49.1%) included strengths and limitations of patient management, generally stating that the most effective treatment for isolated splenic metastasis is unknown because of its rare occurrence and lack of long-term evaluation of interventions. The rationale for this conclusion, including assessment of cause and effect, was not stated in 30.9% of case reports.
Conclusion: Based on a critical evaluation of case reports on isolated splenic metastasis, none completely followed the established CARE guidelines. Most reports did cover diagnostic workup and therapeutic interventions and gave a summary of the literature. Higher quality case reports would be useful in facilitating recognition of rare disease processes and informing clinical practice.
