"In my hands” : Part 9 : The case for case reports

Abstract

Evidence based practice (EBP) was developed to assess available scientific evidence and rank it according to the rigour, strength and precision of the research. It aims to provide guidance for clinicians on which to base therapeutic decisions.1 A number of different hierarchies of evidence have been developed to enable different types of research to be ranked. Systematic reviews, meta analyses and randomized controlled studies (RCTs) usually rank highest because they provide the most reliable evidence of treatment effects. Case reports generally rank low on the scale, just above ideas, editorials and opinions.2 This is because they are susceptible to bias, have no control group, and cannot be used to establish causal relationships between the intervention and the outcome.3 However, systematic reviews and RCTs do have a number of limitations, particularly when applied in the evaluation of rapidly developing technologies, therapeutic devices and procedures, or where it is legally or ethically unacceptable to conduct such studies.