How to Write a Peer Review for a Clinical Case

It has been 1 year since we initiated JACC: Case Reports, and we continuously receive feedback from hundreds of reviewers. In scientific literature, peer reviewers are not only essential gatekeepers that help channel and prioritize information within the field, but they are also hidden contributors to a process that generates high-quality manuscripts. Most reviews for our journal have been thoughtful and detailed, and help both authors and editors highlight the merits of a particular manuscript as well as identify important shortcomings. We have also noticed that some reviewers have struggled to generate constructive reports and meaningfully contribute to the review process. This difficulty could partially stem from the lack of a systematic approach to the review process. Reviewing a clinical case is different from reviewing a research study. Although many clinical cases may be worth publishing in the journal, the editors focus on manuscripts that provide unique clinical insights for practicing cardiologists at all levels of expertise. In the current short summary, we propose helpful hints for reviewers that can make the review process more productive and meaningful.

Conflict of Interest

All reviewers should be mindful of potential conflicts before accepting any manuscript to review. For many, conflicts of interest policies have been associated with original research studies, but some cases describe unique applications of medications or device therapies, and we should similarly follow these policies.

Literature Search

A careful literature search is commonly viewed as the authors’ responsibility, but it is similarly important for reviewers. It is not uncommon for authors to claim that their case is rare or even the first ever described, and the literature search identifies that this is not the case. Several software packages can generate a compatibility score between the manuscript that is being reviewed and existing manuscripts. Manuscripts describing new disease conditions or novel, innovative diagnostic and therapeutic methods are strongly encouraged by the journal. As an example, a case of nonbacterial, nonthrombotic quadravalvular endocarditis caused by deposition of heavy chain immunoglobulin M was recently published in the journal (1). Interventional cases with unique technical challenges and innovative solutions, including 3-dimensional printing, are grouped under Da Vinci Corner.

Plagiarism

It is important to exclude any plagiarism. Although it is rare, we had two manuscripts in which we identified plagiarism. It was suspected by the reviewer and confirmed by the editorial office. Plagiarism is one of the rare circumstances in which rejection of the manuscript is unquestionable.

Manuscript Structure and Flow

It is important to ensure that the manuscript under review has the appropriate structure. Although this is not a reason for rejection, it should be one of the comments for review. Reviewers should familiarize themselves with the author instructions for the journal, which include the various requirements of each article type. In addition, the reviewers commonly help authors to streamline the manuscript and improve the flow. The reviewers can identify missing or redundant pieces of information, broaden differential diagnoses, and offer contrastive criticism on the therapeutic methods. It may be tempting to harshly criticize presented diagnostic or therapeutic strategies, but it is also prudent to give authors a chance to explain and elaborate. Obviously, if there are glaring flaws in the manuscript that are not consistent with established standards of care, these should be communicated to the editor in the appropriate section.

Figures and Tables

Visual information greatly adds to any case presentation and can create a valuable resource for clinical inquiries. The reviewers should make sure that the authors provide high-quality figures that meet the standards of the JACC journals. Annotations are important because they significantly increase educational value by illustrating the pathology versus normal anatomical findings. Certain figures may be improved further by a visual abstract or Central Illustration. Authors are encouraged to provide an algorithm of decision-making if this can improve the quality of the manuscript. In addition, we strongly encourage submission of video clips because they can be conveniently accommodated by our online platform.

References

The reviewers should make sure that references are not only up-to-date but also relevant to the case. The references should support authors’ claims in the manuscript and provide additional resources if the reader requires further clarification.

Educational Value

JACC: Case Reports encourages submission of educational cases, even if they are not unique or rare. The reviewers should view each case through the prism of their own clinical practice and weigh whether the case presentation would help the audience in solving certain clinical dilemmas. Reviewers serve as safeguards to ensure that presented clinical decision-making is consistent with clinical guidelines and established standards of care. At the same time, there are plenty of clinical situations that are beyond the scope of guidelines. Not uncommonly, clinicians make “gray zone” decisions due to a limited evidence base, regional variations in practice, and prevailing opinions. The reviewers may disagree with these decisions but should make an effort to understand the decision-making, explain their disagreement to the editor, and ask for clarifications from authors if in doubt.

When in doubt regarding whether to reject a manuscript, the reviewers should consider whether it might be “resuscitated” by the authors, and whether it brings value to the journal. If rejected, would it be a significant loss for the literature?

Reviewers are an indispensable part of our journal. As editors, we rely on reviewers’ contributions to provide important expertise and to help the authors improve their manuscripts. In the era of significant time constraints for all clinicians, comprehensive peer review from reviewers ensures the quality of JACC: Case Reports as a proud member of the JACC family of journals. We want to thank all reviewers for their contributions and encourage further collaboration!