Using clinical cases to guide healthcare

Abstract

Evidence-based practice (EBP) has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients. The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies, case series and case reports are utilised to support EBP. Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply. A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers. Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals. They are also vital in generating and disseminating early signals and encouraging further research. Whilst these methodologies have weaknesses, particularly with regards to bias and loss of patient confidentiality for rare pathologies, they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

Keywords: Evidence based medicine; Hierarchy of evidence; Case reports; Case series

Core Tip: Evidence-based practice is used by physicians to select the optimum treatment for their patients. The hierarchy of evidence lists systematic reviews and meta-analyses as the highest quality of evidence however this is not always appropriate or possible which is when clinical cases, either as case-control studies or case reports, can be utilised. This paper will look at the strength and weaknesses of these methodologies and use recent examples to demonstrate the impact they can have on clinical practice.