A case series is the most underrated publication in Indian medicine. It requires no ethics heavy trial machinery, no sample size calculation, no year of prospective follow up. It requires patients you have already treated and the discipline to describe them properly.
It is also, for many faculty, the difference between a publication record that counts and one that does not.
What a Case Series Actually Is
A case series is a descriptive report of three or more patients who share a condition, an exposure, an intervention or an outcome. There is no control group and no comparison, which is precisely why it sits low on the evidence hierarchy and why it can be produced quickly.
Case report or case series? One or two patients is a case report. Three or more, described together because they share something meaningful, is a case series. This distinction matters for Indian faculty because single case reports are generally not counted towards NMC promotion requirements, while case series are.
What a case series cannot do is establish cause. Five patients who improved after a treatment tell you those five improved. They do not tell you the treatment worked, because you have no idea what would have happened without it. Writing as though you have shown causation is the fastest way to attract a hostile reviewer.
When a Case Series Is Worth Writing
Editors accept case series that add something. Strong reasons include:
- An uncommon condition where even descriptive data is scarce
- An unusual presentation of a common condition, seen repeatedly
- A rare or previously undescribed adverse effect
- Early experience with a new technique, device or protocol
- A regional pattern that differs from what published literature describes, which is a genuinely strong argument for Indian data
- A diagnostic pitfall that led to repeated delays in management
Weak reasons include: these were interesting, I need a publication, or my department treated many of these. Volume alone is not a finding.
Building the Series From Your Records
Define Your Inclusion Criteria First
Decide, before you go into the records, exactly which patients qualify. Write it down. If you select cases after seeing which ones look best, you have built a biased series and a careful reviewer will notice the gaps.
State the period covered, the setting, the diagnostic criteria used, and any exclusions with reasons. If you screened 40 patients and included 11, say so and explain what happened to the other 29.
Collect the Same Variables for Every Patient
The commonest weakness in submitted case series is inconsistency. Patient 1 has full laboratory values, patient 4 has none, patient 7 has a follow up duration nobody recorded. Build a single table structure before extraction and fill the same fields for everyone, marking genuinely unavailable data as not available rather than leaving blanks.
Typical fields: age, sex, relevant comorbidities, presenting complaint and duration, key examination findings, investigations with values and units, diagnosis, treatment given with doses and dates, complications, outcome and follow up duration.
Ethics and Consent
Consent for Publication
Nearly every journal requires written consent for publication from each patient whose details appear, even when names are removed. This is a different document from the consent taken for treatment. It should tell the patient that their clinical details, and any images, may appear in a medical journal that is publicly accessible, and that complete anonymity cannot be guaranteed.
Take consent on the journal own form where one exists. Keep the signed forms. Do not send them with the manuscript unless asked, but be ready to produce them.
Deceased or untraceable patients: do not simply proceed on the assumption that anonymisation is enough. Write to the editor before submission, explain the circumstances, and ask how they wish you to proceed. Some journals accept consent from next of kin, some accept an editor level waiver, and some will decline.
Ethics Committee
Many institutional ethics committees regard a retrospective, anonymised case series as exempt from full review or eligible for expedited review. That determination is theirs to make. Submit, obtain the letter, and quote its reference number in your methods. Journals ask.
De-identification Done Properly
- No names, hospital numbers, addresses or phone numbers anywhere, including inside image files
- Report age in years, or in a range for very old patients, rather than a date of birth
- Remove dates that could identify an admission, using intervals such as day 3 after admission instead
- Crop or mask identifying features in clinical photographs, and check that eye masking is genuinely non-identifying
- Strip metadata from images, because camera files routinely carry the date, device and sometimes the location
- Remove patient identifiers burned into radiology and pathology images, which is a very common oversight
How to Structure the Manuscript
Title
Name the condition, say it is a case series, and give the number. For example: Delayed Presentation of Splenic Injury After Blunt Abdominal Trauma: A Series of Seven Cases. Journals and search engines both reward this clarity.
Abstract
Usually 150 to 250 words. State the background, what the series describes, the key features across the patients, and the practical message. Check whether your journal wants a structured or unstructured abstract.
Introduction
Short. Two to three paragraphs establishing what is known about the condition, what remains unclear, and why this group of patients is worth reporting. State the gap explicitly.
Methods
Many authors skip this in a case series, which is a mistake. State the setting, the period, how cases were identified, the inclusion and exclusion criteria, the ethics committee decision and reference, and the consent process. This section is what separates a systematic description from an anecdote.
Case Descriptions
Two approaches work.
Individual narratives suit small series of three to six patients where each has a distinct story. Keep the order of information identical across patients so the reader can compare.
A summary table plus a narrative of patterns suits larger series. Give every patient a row, then discuss what they share and where they differ. Beyond six or seven patients, individual narratives become tedious to read.
Always include the table. Even with individual narratives, a summary table lets a reviewer see the whole series at a glance. Its absence is one of the most frequent revision requests.
Discussion
This is where a case series earns acceptance or rejection. Structure it as: what the series shows, how it compares with published literature, what might explain the pattern, what the limitations are, and what a clinician should take away.
State the limitations plainly. A case series is retrospective, has no control group, describes a single centre, and cannot establish causation. Naming these yourself is far better than having a reviewer name them for you.
Conclusion
Two or three sentences, proportionate to the evidence. "Clinicians should consider this diagnosis in patients presenting with X" is defensible. "This treatment should be adopted" is not, from a series of six.
Reporting Guidelines and Formatting
The CARE guideline was written for case reports and is widely applied to case series as well. Some surgical journals prefer the PROCESS guideline for surgical case series. Check what your target journal specifies, complete the checklist, and submit it if requested.
Watch the practical limits: word count, number of tables and figures, reference count, and image resolution. Case series submissions are frequently returned unreviewed for exceeding a figure limit, which is a wasteful way to lose two weeks.
Why Reviewers Reject Case Series
- No clear message, just a description of some patients
- Cases selected after the fact to fit a narrative
- Missing data for several patients with no explanation
- Discussion that is a literature review with no reference back to the cases
- Causal claims the design cannot support
- No consent statement and no ethics committee reference
- Identifiable details left in images or text
- A series of three where the three patients have nothing meaningful in common
A Realistic Timeline
A case series is the fastest legitimate publication available to a working clinician. Case identification and record extraction take one to two weeks. Consent collection takes one to three weeks and is usually the slowest step. Writing takes one to two weeks, and journal formatting takes a few days. Peer review then follows its own schedule, commonly two to six months.
If you are choosing between article types for a promotion deadline, our guide on which type of article to write compares the options by effort, evidence level and recognition.
Frequently Asked Questions
How many cases make a case series?
Most journals treat three or more patients as a case series, and one or two as a case report. There is no universal rule, so check the definitions in your target journal instructions to authors. Below three patients, expect the journal to classify your submission as a case report regardless of what you call it.
Does a case series count for NMC promotion when a case report does not?
Under the National Medical Commission teaching eligibility framework, single case reports are generally not counted towards the publication requirement for faculty promotion, while case series are. Because these regulations are revised periodically, verify the current requirement for your designation before relying on it, and confirm the journal is indexed in a recognised database.
Do I need ethics committee approval for a case series?
Requirements vary. Many institutional ethics committees consider a retrospective, anonymised case series exempt or eligible for expedited review, but that determination must come from the committee rather than from you. Written patient consent for publication is a separate requirement and is expected by almost every journal regardless of the committee decision.
Can I publish a case series without patient consent if I remove all names?
No. Removing names is not the same as consent, and most journals require signed consent for publication of patient details or images even after de-identification. If a patient has died or cannot be traced, contact the journal editor before submission and explain the situation, rather than assuming anonymisation is sufficient.
Have Three or More Interesting Cases?
A case series is often the fastest route to a promotion eligible publication. We help with structure, literature framing and journal formatting.
Talk to Us →This article is general educational guidance, not legal advice. Journal policies, regulatory rules and institutional requirements change. Always check the current instructions to authors of your target journal and the current guidance of your institution, the NMC and the ICMR before acting.