Multicenter Case Report — Collaborative Clinical Documentation Across Sites
Multicenter Case Report · Also known as: multi-site case report, collaborative case report, multicentre case report, CARE multicenter report
A multicenter case report is a structured clinical document describing one or a very small number of unusual patients observed across two or more independent healthcare institutions. By pooling observations from multiple sites, it overcomes the rarity barrier that prevents any single center from documenting an unusual presentation, adverse event, or novel treatment response — producing a richer, more externally valid account than a single-center report can offer.
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When to use it
Use a multicenter case report when a clinical entity — a rare disease presentation, an unexpected adverse event, a novel procedure outcome — is so uncommon that no single institution can independently accumulate even two or three cases within a reasonable timeframe. It is the appropriate design when the aim is to document, describe, and alert the clinical community to a phenomenon rather than to test a hypothesis. It is particularly valuable for: describing first-in-human or first-in-class events; documenting unexpected drug interactions or off-label outcomes; raising hypotheses for future observational or interventional studies. Do NOT use it when you have enough cases to constitute a proper case series (typically five or more), when the research question requires a control group, when incidence or prevalence estimation is needed, or when causal inference is required — those questions demand cohort, case-control, or experimental designs.
Strengths & limitations
- Enables documentation of entities too rare for any single center to report independently.
- Cross-site consistency of clinical findings strengthens the credibility of the description beyond what a single-center report can achieve.
- Produces hypothesis-generating signals for subsequent larger studies.
- Alerts the global clinical community rapidly to novel presentations, adverse events, or treatment responses.
- CARE guidelines provide a standardized, peer-reviewed reporting framework that supports transparency and reproducibility.
- The total number of cases remains very small; findings cannot be generalized to a population and no statistical inference is possible.
- Coordination across institutions adds logistical complexity: varying ethics board requirements, different data-governance rules, and consent processes.
- Retrospective assembly of records across sites introduces the risk of incomplete or inconsistently recorded data.
- Selection and reporting bias are difficult to eliminate — cases are reported partly because they are unusual or had notable outcomes, not because they are representative.
Frequently asked
What distinguishes a multicenter case report from a multicenter case series?
The distinction is primarily numerical: a case report describes one to three patients (occasionally up to four or five in practice), while a case series involves a larger set — typically five or more. In both designs the patients are selected based on sharing an unusual feature, with no control group. The multicenter qualifier means the patients were treated at different institutions, not just different departments of the same hospital.
Do all participating institutions need separate ethics approval?
In most jurisdictions, yes. Each institution is independently responsible for the ethical oversight of patient data originating within it. Some countries permit a lead-site approval model for collaborative case reports, but this must be confirmed with each institution's ethics board. Failure to obtain site-specific approval is a common cause of manuscript retraction.
Are CARE guidelines mandatory for submission?
CARE guidelines are required by a growing number of clinical journals and recommended by the EQUATOR Network for all case reports. Even where not mandatory, following them substantially improves completeness, transparency, and the likelihood of acceptance. The CARE checklist is freely available at care-statement.org.
Can a multicenter case report establish causality?
No. Like all case reports, it is a descriptive design that cannot establish causality. Cross-site consistency of an association (e.g., a drug and an adverse event) strengthens the hypothesis but does not test it. Causal inference requires controlled study designs such as randomized trials or, for rare exposures, well-designed case-control studies.
How should authorship be assigned across institutions?
Authorship should follow ICMJE criteria: all listed authors must have made substantial contributions to conception or design, data acquisition or analysis, drafting or critical revision, and approval of the final version. A common approach is to list the lead clinician from each site as a co-author, with contributors who do not meet all four ICMJE criteria acknowledged in a contributors section.
Sources
- Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., & Riley, D. (2013). The CARE guidelines: Consensus-based clinical case reporting guideline development. Journal of Medical Case Reports, 7, 223. DOI: 10.1186/1752-1947-7-223 ↗
- Case report. Wikipedia. link ↗
How to cite this page
ScholarGate. (2026, June 3). Multicenter Case Report. ScholarGate. https://scholargate.app/en/epidemiology/multicenter-case-report
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Case seriesEpidemiology↔ compare
- Multicenter case seriesEpidemiology↔ compare
- Multicenter cohort studyEpidemiology↔ compare
- Retrospective Case ReportEpidemiology↔ compare