EditverseCase reports: CARE checklist, patient consent and timeline figure
The 13 CARE items with what each needs in the manuscript, what consent for publication has to cover under the ICMJE Recommendations, how to de-identify images, and how to draw the timeline.
Key points
- The CARE guidelines are a 13-item checklist for case reports: title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic intervention, follow-up and outcomes, discussion, patient perspective and informed consent.
- Item 7 asks for a timeline, as a table or a figure, showing the important dates and times in the case.
- Item 13 asks whether the patient gave informed consent. Under the ICMJE Recommendations (January 2026), consent for publication is written, and an identifiable patient must be shown the manuscript.
- Covering the eyes in a photograph is not adequate de-identification. Remove every detail that is not needed to make the clinical point.
- The patient perspective (item 12) is part of the checklist and is included whenever possible.
What CARE is
The CARE (CAse REport) guidelines were developed by a consensus group of 27 participants and published in 2013 and 2014 in several journals.1 They consist of a 13-item checklist. An explanation and elaboration paper published in 2017 takes each item in turn with examples from published reports.2 The checklist in current use is on the CARE website, with translations.3
CARE was written for reports of a single patient. A case series that describes several patients individually can follow the same items for each patient, with a shared introduction and discussion. Journals differ on whether they accept case reports at all and on length limits, so the target journal's article types should be checked before writing.
The 13 items and what each needs
| No. | Item | What CARE asks for | Practical note |
|---|---|---|---|
| 1 | Title | The words "case report" together with the diagnosis, intervention or finding of main interest | Put the phrase at the end after a colon; it is how the report is indexed and found |
| 2 | Key words | Two to five key words identifying the main elements of the case | Include "case report" as one of them where the journal allows |
| 3 | Abstract | What the case adds; the main symptoms, findings, diagnoses, interventions and outcomes; the main lesson | Structured or unstructured as the journal requires |
| 4 | Introduction | A brief background with reference to the relevant literature, and why the case is worth reporting | One or two paragraphs. State the claim of novelty precisely and support it with a described search |
| 5 | Patient information | De-identified demographic details; main concerns and symptoms; medical, family and psychosocial history; relevant past interventions and outcomes | Give age as a number or decade, and only the occupation or ethnicity that bears on the case |
| 6 | Clinical findings | Relevant physical examination and other important clinical findings | Report pertinent negatives as well as positives |
| 7 | Timeline | Important dates and times in the case, organised as a table or figure | See the worked figure below |
| 8 | Diagnostic assessment | Methods used; diagnostic challenges; reasoning, including other diagnoses considered; prognostic characteristics where applicable | Give test values with units and reference ranges |
| 9 | Therapeutic intervention | Type of intervention; administration (dose, strength, duration); changes with reasons | Use generic drug names, route and exact dose |
| 10 | Follow-up and outcomes | Clinician-assessed and patient-assessed outcomes; important follow-up test results; adherence and tolerability and how they were assessed; adverse and unanticipated events | State the length of follow-up and the patient's status at last contact |
| 11 | Discussion | Strengths and limitations of the approach to the case; the relevant literature; the rationale for the conclusions; the main lessons | Keep causal language in proportion to one patient |
| 12 | Patient perspective | The patient's own account of the experience, whenever possible | A short paragraph in the patient's words, approved by the patient |
| 13 | Informed consent | Whether the patient gave informed consent, to be provided if requested | A statement in the manuscript; the signed form held as the journal directs |
The CARE authors note three matters that the checklist does not list but that journals often require: a statement of competing interests, de-identification of patient data, and ethics committee or institutional review board approval where it was obtained or is necessary.1 Check the target journal for each.
Consent for publication
Consent to treatment and consent to publication are different documents. A patient who agreed to an operation has not agreed to appear in a journal. The CARE authors state that authors have an ethical duty to obtain the patient's informed consent to publish, and that consent becomes informed when the patient, or a relative, reads the case report and approves its content.1
The ICMJE Recommendations, updated January 2026, set the rule that most journals apply.4
| Requirement | What it means for the author |
|---|---|
| Written consent | Identifying information is not published in descriptions, photographs or pedigrees unless it is essential for scientific purposes and the patient, or a parent or guardian, has given written informed consent for publication |
| The patient sees the manuscript | For an identifiable patient, informed consent requires that the patient be shown the manuscript to be published. Show the final text and every image |
| Online availability explained | Authors should tell the patient whether potentially identifiable material may be available on the internet as well as in print after publication |
| Archiving | Consent is written and archived with the journal, the authors, or both, as local regulations or laws dictate. Some journals ask the author to hold the form and supply a written statement that it has been obtained |
| Statement in the article | When informed consent has been obtained, the published article should say so |
| Doubt about anonymity | Consent should be obtained whenever there is any doubt that anonymity can be maintained |
Three practical points follow. First, use the journal's own consent form if it has one; some journals will not accept an institution's general form in its place. Second, obtain consent before writing, and return to the patient with the finished text. Third, plan for the situation where consent cannot be obtained. CARE advises that if the patient cannot consent and attempts to find a relative to give proxy consent have failed, the authors should seek permission to publish from an institutional committee.1 Whether a journal will accept that route is the journal's decision, so ask the editorial office before submitting.
Illustrative consent statement
Written informed consent for publication of this case report and the accompanying images was obtained from the patient, who read the final manuscript. The signed consent form is held by the authors and is available to the editor on request.
Ethics committee approval is a separate question. Some institutions do not require committee review for a single case report, others require notification or a waiver, and journals may ask for a statement either way. Ethical oversight is one of the ten areas on which COPE expects journals to have a stated policy, so the journal's own rule will be in its instructions for authors.5 State what your institution requires and what was done.
De-identifying text and images
The ICMJE Recommendations ask that names, initials and hospital numbers are not published, that non-essential identifying details are omitted, and they state directly that masking the eye region in photographs is inadequate protection of anonymity. Where identifying characteristics are altered to protect the patient, authors should give an assurance that the changes do not distort scientific meaning.4
In practice this means working through the following before submission.
- Text. Remove the hospital name where a small unit and a rare condition together could identify the patient. Give age and timing in the least specific form that preserves the clinical meaning. Leave out occupation, place of origin and family details unless they matter to the diagnosis.
- Radiology. Export images without the patient banner: name, date of birth, record number, accession number, institution and scan date. Check the corners of every frame and any burned-in annotation.
- Clinical photographs. Crop to the lesion. Remove jewellery, tattoos, birthmarks and backgrounds that are not part of the finding. A recognisable face needs explicit consent for that image.
- Pathology and laboratory images. Remove slide labels and specimen numbers.
- File properties. Clear embedded metadata from image and document files, and rename files so that no name or record number appears in the file name.
Before-and-after images should be taken with the same intensity, direction and colour of light, and photomicrographs need an internal scale marker and the staining method.4
Drawing the timeline
CARE recommends a timeline that shows how the key events of the case unfolded. It may include relevant past and family history, current symptoms, diagnostic test results, interventions and events during follow-up.1 A table is acceptable; a figure is easier to read when treatment periods overlap with events.
Build it in four steps.
- List every dated event from the notes: symptom onset, presentation, each key investigation, the diagnosis, the start and end of each treatment, complications, discharge and each follow-up contact.
- Choose the time axis. Set presentation as day 0 and express everything else as days, weeks or months before or after it. Intervals keep the sequence clear and avoid printing calendar dates that could help identify the patient. If the journal asks for dates, give month and year.
- Separate points from periods. Tests and decisions are points. Drug courses and admissions are bars with a start and an end.
- Check it against the text. Every event on the timeline should appear in the narrative with the same timing, and no event in the narrative should be missing from it.
The figure below uses a fictional patient. The condition, timings and outcome are invented for illustration.
Keep the figure to the events a reader needs to follow the reasoning. Six to ten points is usually enough. Laboratory values belong in a table, with the timeline showing only when they were taken.
Order of work for a case report
- Before writing
- Confirm the journal accepts case reports. Obtain consent for publication on the journal's form. Check what your institution requires from its ethics committee.
- From the notes
- Extract the dated events and build the timeline first. The narrative sections (items 5 to 10) are then written along it.
- Literature
- Search for similar reports and record the search, so that any statement about rarity in the introduction and discussion rests on something a reviewer can check.
- Before submission
- De-identify text and images. Show the patient the final manuscript. Add the patient perspective. Complete the CARE checklist with the location of each item.
Our case report and case series writing service works from de-identified case notes, investigations and images, and delivers the manuscript with a timeline figure, the completed CARE checklist and consent-statement wording. Obtaining the patient's consent remains with the treating clinician. Other manuscript types are described under journal manuscripts, and a report that is already written can go through medical manuscript editing.
The patient has died or cannot be contacted. Can the case still be published?
CARE advises seeking consent from a relative and, if that fails, permission from an institutional committee. Journals set their own rules for this situation, and some will not publish without consent from the patient or next of kin. Ask the editorial office before preparing the submission.
Is consent needed if the report contains no photographs?
The ICMJE Recommendations cover written descriptions as well as images, and say consent should be obtained if there is any doubt that anonymity can be maintained. A rare condition in a named hospital can identify a patient without any image. Many journals require consent for every case report.
Does a case report need ethics committee approval?
Requirements differ between institutions and countries. CARE notes that journals often ask authors to address ethics committee approval if it was obtained or is necessary. Follow your institution's rule and state in the manuscript what was done.
Should the timeline be a table or a figure?
CARE accepts either. Use a table when there are many dated test results, and a figure when treatment periods and events overlap. Check whether the journal counts it against its limit on display items.
References
- Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group. The CARE guidelines: consensus-based clinical case report guideline development. J Clin Epidemiol. 2014;67(1):46-51. PMID 24035173 · DOI. Open-access co-publication: J Med Case Rep. 2013;7:223. PMID 24228906
- Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218-235. PMID 28529185 · DOI
- CARE Case Report Guidelines. CARE checklist. care-statement.org/checklist
- International Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. Updated January 2026. icmje.org/recommendations
- Committee on Publication Ethics. Core practices. publicationethics.org/core-practices