A case report (CR) is the documentation in the scientific literature of a single clinical observation. CRs allow clinicians to share unusual, rare or new findings related to a disease or treatment, but they are considered to be the lowest level of evidence due to their anecdotal nature. With the increased advocacy of evidence based medicine (EBM), CRs are increasingly sidelined and assumed to have minimal impact on the management of patients. Advocates of CRs think they have significant value and impact within the medical literature. Their potential roles include describing new diseases, describing new treatments of known diseases, identifying the aetiology or mechanism of disease, recognizing rare manifestations of disease, detecting adverse/beneficial drug side effects, medical education, and audit.

Journal impact factor (IF) is a measure of the frequency with which the ‘average article’ in a journal has been cited in a particular year or period. It was developed by the Institute of scientific information (ISI) in the 1960s primarily as a bibliometric tool to assist libraries in selecting relevant journals for their holding. IF is derived by calculating the ratio between citations received in a particular year and the number of articles published in the two preceding years for a particular journal. IF increases with an increase in citations and a reduction in the number of articles published. The citation rates of CRs are often minimal so most major journals restrict or do not accept CRs because they may lower journal IF.

In the field of oral and maxillofacial surgery (OMS), CRs are generally published in all major journals of the specialty as a platform for sharing unusual events and treatments among peers. There are two important issues regarding CRs. The first, and most discussed, is the effect of publishing CRs on journal IF. Authors aim to publish in journals with the highest IF so that they are better rewarded by their institutions and research funding bodies. Journal editors seek to achieve the highest IF possible for their journal in order to attract the best manuscripts thus increasing the prestige of the journal and its parent organization or specialty. The second, more important but less prominent and less addressed, issue is the impact of CRs on the OMS specialty through their effect on future research and patient care in the long term. The aim of this study was to investigate both these aspects in order to describe the relevance of CRs to the OMS specialty.

Materials and methods

All CRs published in major English language OMS journals ( Table 1 ) from January 2007 to December 2008 were searched manually by the first author. The period was selected to assess the current situation while also giving enough time for any citing article to be published. The CRs were identified by screening the title and abstract of all published articles in 2007 and 2008 within each journal. The full text of articles was retrieved when data from the title/abstract were insufficient to make a decision. Only articles meeting the predefined criteria ( Table 2 ) were identified as CRs and included in the review.

Table 1

Major OMS journals.

Major Oral & Maxillofacial Surgery Journals	2009 impact factor
Journal of Oral and Maxillofacial Surgery (JOMS)	1.580
International Journal of Oral & Maxillofacial Surgery (IJOMS)	1.444
British Journal of Oral & Maxillofacial Surgery (BJOMS)	1.327
Journal of Cranio-maxillofacial Surgery (JCMS)	1.252

 

Table 2

Criteria for inclusion in this review.

Case reports
1. No more than 5 patients
2. Full demographic and clinical background of each patient within the report
3. Must be citable by Institute for Scientific Information Web of Science (ISI)
4. Must be a full article (case reports within letters to editors, conference abstracts were not accepted)

 

All CRs identified within the study period were classified as either: rare disease or pathology (RDP); or new treatment or diagnostic method (NTD). The ISI citation received by each CR was then retrieved from the ISI online databases. All the citation data were collected during the first week of August 2011 to ensure minimal changes to the number of citations over the time it took to conduct the study. Two different citation data were collected: citations received by the CR article in 2009; and total citations received by the CR from the date it was citable to the date of data collection (August 2011). The first citation data were used to answer the first objective (effect of CRs on journal IF) and the total citation rate was used for the second objective (impact of CRs on the OMS specialty). The data were entered into an Excel table. Any disagreements about selection or categorization of articles were resolved by discussion between the authors. The flow chart of the methodology is shown in Fig. 1 .

Flow diagram of study methodology.