OPINIONI - Opinions
Biochimica Clinica 2012; 36(2) 121-125
Casi clinici e medicina di laboratorio basata sulle prove
Laboratorio di Chimica Clinica ed Ematologia, Ospedale San Bortolo, Vicenza
Evidence-based medicine (EBM) case reports in laboratory medicine
Case reports are not a source of strong evidence for the EBM. Systematic reviews usually take into account all sources of evidence, but using a hierarchy for scientific publications, putting randomized controlled trials first, followed by nonrandomized trials, cohort and casecontrol studies, while case reports come last. However, the EBM movement soon has had to care not only of evidence theory, but also of the application to clinical practice, integrating the best external available evidence with the individual clinical expertise and patient expectations. To deal with the necessity to apply the research evidence to individual patients, in 1998 the British Medical Journal launched a new type of articles; the evidence-based case reports. These reports should attempt to show how evidence can be applied at all stages of patient care. Basically, case reports can have at least two fields of application in EBM, in addition to learning: in new cases due to the occurrence of unknown disease or use of new technologies and in adverse or rare events (for instance, unusual outcome or condition not considered by recommendations). As an example, the AIDS was first described in a case report on the American Journal of Dermatophatology. We use case reports every day, talking with our clinical colleagues, making a counselling or discussing on a mailbase list. Eventually, the diagnostic process can often be
compared to an investigation process, as Sherlock Holmes said (“There is nothing like firsthand evidence”). Case reports possibly are part of it.