Table 3.

Evaluation of a case report according to the Piersons 5-component scheme

Component	Points	Criteria
Documentation	2	Complete, accurate, appropriate: everything needed to demonstrate that case is what the author contends it is, including appropriate diagnostic tests and images; no coexisting conditions or manifestations casting doubt on diagnosis, attribution of findings, or reasons for observed events; appropriate citation of references for case documentation
	1	Most usual criteria for diagnosis, manifestations, or outcome are fulfilled, although confirmatory or additionally instructive data/images not included; case is apparently as the author claims, although additional documentation would strengthen it; references appropriate but suboptimal
	0	Insufficient data provided to be certain that the reported findings, phenomena, or events were due to claimed mechanism and not something else; other explanations not adequately excluded; incomplete references for documentation
Uniqueness	2	Satisfactory demonstration that the manifestation, finding, complication, course, or intervention described has not previously been reported; appropriate citation of references to support uniqueness
	1	Although previously reported in the literature, this is the first report in this field or in this journal; references cited to substantiate this
	0	Subject of report has previously been documented in this field or in this journal; potential uniqueness cannot be determined from report
Educational value	2	Case described exactly fulfills accepted definition and/or description, without missing or atypical features; case is sufficiently “classic” or typical that reader could use it as a template for the future with respect to the condition or point under discussion; case and discussion facilitate comprehension and appreciation of topic; references complete, appropriately recent, and accessible, providing opportunity for further learning on topic
	1	Case has general attributes of claimed entity or occurrence, but with missing, atypical, or contradictory features rendering it less than a “classic” example; incomplete discussion of topic for optimal instructional benefit in allotted space; references less than ideal
	0	Case is sufficiently incomplete or atypical that generalization to other cases could be confusing or misleading; case lacks important aspects of “classic” description of entity under discussion; instructional content weak or very incomplete; references incomplete, irrelevant, outdated, or inaccessible
Objectivity	2	Data complete, contemporaneous, and presented in format appropriate for setting; no evidence of selective data presentation or emphasis; absent or atypical features identified and explained; possible alternative diagnoses or explanations listed and discussed; citation of alternative or contradictory sources provided if warranted; no evidence of author advocacy or bias related to conflict of interest
	1	Data presented in appropriate format but with uncertain completeness, timing or selection; evidence of subjectivity or selectivity in presentation of case; discussion presented such that incomplete or atypical features or alternative explanations are omitted or deemphasized; undue emphasis on references supporting author’s position
	0	Selective presentation of data; evidence of author bias in favor of claimed diagnosis, event, intervention, or commercial product, with insufficient presentation of inconsistent, or contradictory material; inadequate presentation and consideration of alternative explanations or approaches; only references supporting author’s position are cited
Interpretation	2	Conclusions and recommendations conservative, restricted to those consistent with and supported by evidence presented, and appropriately linked to cited literature; if reporting something new, acknowledgement by author of limitations of individual case and need for additional evidence; any conjectures about mechanisms or implications for therapy clearly identified as such; avoidance of general clinical recommendations extending beyond context of case
	1	Some conclusions overstep the data presented, although general clinical recommendations based on this case are avoided; incomplete linkage of presented data to literature
	0	Extrapolation of conclusions about mechanisms or interventions well beyond the data presented; literature citation in support of conclusions biased and/or incomplete; statement of general recommendations for patient management or use of therapy, clinical approach, or commercial product based solely on this case

Implications of total score: 9–10: report is likely to be a worthwhile contribution to the literature, 6–8: reader should be cautious about validity and clinical value of report, 5 or less: report is of insufficient quality for publication