Critical analysis of the reporting quality of case reports focusing on dental traumatology using the Preferred Reporting Items for Case reports in Endodontics 2020 checklist: A baseline evaluation prior to checklist publication

Background/Aims: The Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 guidelines were published to help authors produce high-quality case reports. The aim of


| INTRODUC TI ON
Case reports focus on new, rare, or unusual features of diseases or their management and have the potential to provide valuable information on novel or improved care packages, leading to enhanced clinical decision-making. 1 Although often considered low-quality evidence, case reports can provide information that can be subsequently applied in clinical practice, as well as data on the therapeutic efficacy, adverse effects, and costs of interventions.[3][4] There is widespread agreement that research and reporting guidelines are essential for enhancing the quality of the healthcare literature. 5Reporting guidelines are intended to assist authors by enhancing the completeness, transparency, and accuracy of their reports, thus decreasing the volume of inadequately written manuscripts submitted to scientific journals. 6e Preferred Reporting Items for Case Reports in Endodontics (PRICE 2020) guidelines 7 were developed by combining and modifying the CAse REport (CARE) guidelines 8 and the Clinical and Laboratory Images in Publications (CLIP) principles. 9The CARE guidelines 8 were developed to improve the quality of case reports within the field of Medicine whilst the CLIP principles 9 were developed to provide readers with the information necessary to evaluate the accuracy, comprehensiveness, and authenticity of the understanding and significance of photographs and other images published in scientific journals.
Seguel-Moraga et al. 10  and Pediatric Dentistry.They reported deficiencies in multiple CARE items, such as the absence of the "patient perspective" and "informed consent" in all case reports.Notably, Tewari et al. 11 reported that compliance with the CARE guidance for the decade 2012-2021 was higher than those for the decade of 2002-2011, which demonstrates the advantages of using the guidelines.
Berlin-Broner and Levin 12 evaluated the quality of 70 case reports published between January 2015 and March 2020 in the International Endodontic Journal and the Journal of Endodontics.When using the PRICE 2020 guidelines, they identified several deficiencies and suggested that the use of the checklist would help authors prepare case reports to an appropriate standard in the future. 12e quality of case reports submitted to Dental Traumatology and the International Endodontic Journal is variable and often suboptimal (Abbott P, Levin L, Dummer PMH, Duncan HF, unpublished data).
Many reports are incomplete and inaccurate and are consequently rejected.As a result, Dental Traumatology endorsed the PRICE 2020 guidelines in 2021 with the requirement that all case reports submitted to the journal must follow these guidelines. 13e aim of this study was to appraise a sample of 50 case reports related to dental traumatology in order to determine compliance with the PRICE 2020 guidelines, provide baseline data on the quality of existing reports, and thus educate authors for future reports.
Importantly, the study only included reports published prior to the introduction of the PRICE guidelines and did not include case reports that may have benefited from the introduction of the reporting guidelines.

| Selection of case reports
Case reports published within the field of dental traumatology between January 2015 and December 2019 were extracted from the PubMed database using the following search strategy: (((((((((((((((("dental trauma") OR ("dental traumatism")) OR ("dental traumatic injuries")) OR ("traumatic dental injuries")) OR ("crown fracture")) OR ("complicated crown fracture")) OR ("uncomplicated crown fracture")) OR ("root fracture")) OR ("tooth fracture")) OR ("tooth injury")) OR ("avulsion")) OR ("extrusion")) OR ("luxation")) OR ("alveolar fracture")) OR ("intrusion")) OR ("traumatic pulp exposure")) AND ("case report").The publication details for each case report identified in the PubMed database were exported to an Excel spreadsheet and a four-decimal-point, from 0-to-1, random number was assigned.Random numbers were generated and sorted in ascending order, thus re-ordering the retrieved articles.Titles and abstracts of the first 50 eligible case reports were screened based on the inclusion criteria.If a chosen case report did not meet the criteria, it was replaced with the next case report in the random sequence until a total of 50 case reports were chosen.Two independent reviewers (VKG and VN) were involved in case report selection, with disagreements resolved by a third independent reviewer (PA).

| Inclusion criteria
Case reports related to dental traumatology that discussed only one case and were published in any journal in English between 2015 and checklist publication.It is recommended that authors follow the PRICE 2020 guidelines to improve the overall quality of their case reports.

K E Y W O R D S
case report, dental traumatology, PRICE 2020, reporting quality 2019 were included.This ensured the reports were published prior to the PRICE 2020 guidelines becoming available.Clinical trials, observational studies, case series, laboratory-based studies, animal studies, and reviews were excluded.

| Data extraction
Details of the 50 case reports were summarized using a data extraction sheet that included the name of the first author, the country of the corresponding author(s), the year the study was published, the total number of authors, the name of the journal, and the impact factor (IF) of the journal for the year that the report was published.Two independent reviewers (VKG and VN) extracted data autonomously, with disagreements resolved by a third independent reviewer (PD).

| Appraising the quality of the case reports
Three of the 50 case reports were randomly selected to test the interpretation and effectiveness of the scoring system.Two reviewers (SKS and YBB) conducted the pilot test, with discrepancies and disagreements resolved by team members.Finally, all 50 articles were evaluated independently by the two reviewers (SKS and YBB), and a consensus score was determined for each item within each manuscript.
Disagreements were resolved by a third independent reviewer (LL).
The adherence of the manuscripts to each of the 47 items on the PRICE 2020 checklist was evaluated to determine the reporting quality of the case reports.Each item was given a score of "1" if the manuscript satisfied all relevant criteria, "0" if it was not reported, and "0.5" if it was reported inadequately."Not Applicable" (NA) score was given to items that were not relevant to a particular report.The total PRICE score for each case report was calculated by adding all of the scores, with a maximum score of 47 minus any "NA" scores.
Association between the following parameters and mean quality scores of case reports were investigated: 1. geographical source of reports in terms of the continent of the corresponding author (Africa vs North America vs South America vs Europe vs Asia vs Oceania); 2. published in a journal with an IF for the year in which the case report was published (yes/no); 3. period of publication (2015-2017 vs 2018-2019); and 4. journal adherence to the CARE guidelines (yes/no).

| Statistical analysis
The data were tabulated in an Excel sheet and statistically analyzed using the SPSS software (Version 28; IBM Corp).Descriptive statistics were used to summarize the characteristics of the case reports and the variables of interest.The Student's t-test was used to identify the statistical significance between the mean scores of (i) year categories (2015-17 and 2018-19), (ii) Journal adherence to CARE guidelines (categorized as yes or no), and (iii) IF of the journals (categorized as yes or no).One-way ANOVA with Tukey's post hoc test was used to identify the significant difference in the mean scores of the three continents Asia, Europe, and South America.The p-value was set at 5%.

| RE SULTS
The characteristics of the 50  included case reports are presented in Table 1. The mjority of the corresponding authors were from Brazil (n = 11) and India (n = 11).The number of authors associated with each report ranged from 1 to 9.
Table 2 presents the percentage of case reports that met each applicable item of the 47 criteria provided by the PRICE 2020 guidelines.The percentage of case reports that fully met each applicable item ranged widely from 0% (item not met in any case reports, despite being applicable) to 100% (item fulfilled in all the case reports, where applicable).The percentage of case reports partially satisfying each applicable item varied widely, ranging from 0% (item not partially fulfilled in any case reports, despite being applicable) to 88% (item partially fulfilled in all the case reports, where applicable).
Of the 47 criteria recommended by the PRICE 2020 guidelines, the number of items identified as applicable in each of the 50 included case reports ranged from 36 to 44 (Table 3).The scores of individual reports, based on the proportion of applicable items that met the criteria, are presented in Table 3.The average score of the papers included was 63.6%.The minimum score for a paper was 36.6% while the maximum score was 79.1% (Table 3).Table 4 presents the relationship between scores of the included case reports and characteristics of the papers (year of publication, continent, journal adherence to CARE guidelines, journals with or without IF).Of the 50 case reports, 28 were published in journals with an IF and 22 in journals without an IF.The scores of case reports published in journals with an IF were significantly higher compared with those published in journals without an IF (p = .042).The case reports from Europe had higher scores followed by Asia and South America.Scores for European case reports were significantly higher compared with those from South America (p = .004),whereas no significant difference was observed between Asia and Europe (p = .092),or Asia and South America (p = .214).No significant difference (p = .606)was observed between the mean scores comparing the periods of publication (2015-2017 and 2018-2019).Only 15 of the 50 case reports were published in journals that adhered to the CARE guidelines with no significant difference (p = .337)between those that adhered to the CARE guidelines and those that did not.

| DISCUSS ION
The PRICE 2020 guidelines 7 were developed by experts from around the world using a validated consensus-based methodology. 64The PRICE 2020 guidelines include a checklist with 12 sections and 47 items, as well as a flowchart with 19 steps that summarize the stages involved in case report development.
The PRICE 2020 guidelines were recently added to the EQUATOR Network. 65Due to the importance of the PRICE 2020 guidelines, various journals such as the International Endodontic Journal, 66 Australian Endodontic Journal, 67 Turkish Endodontic Journal, 68 Saudi Endodontic Journal, 69 and Dental Traumatology 13  checklist, which aligns with the two previously published studies that used the CARE guidelines 10,11 This demonstrates that the standards of reporting of case reports related to dental traumatology could be improved.This improvement can be achieved if authors adhere to the PRICE 2020 guidelines and journals insist that submissions comply with these guidelines.
The PRICE 2020 checklist has two items within the "Title" domain.Of concern was the finding that only 56% of the reports mentioned the term "case report(s)" in the title.In order to ensure that readers are aware of the nature of the article, authors should be required to include the phrase "case report(s)" in the title.This also allows for the article to be indexed in databases that can be subsequently searched. 70Authors should add the area of interest in the title, which enables readers to identify the topic of the case report. 70Only 18% of case reports included adequate information on how the report was unique or addressed "a gap" in knowledge. The overview of the most significant characteristics of the submitted case(s). 70irty-six percent of the case reports mentioned adequate details of how informed consent was obtained.Authors must include a declaration stating the patient gave their informed, valid consent for the treatment and, ideally, for the reporting of the case. 70In only 14% of the reports were the pertinent dates and times of the case presented in chronological order.A brief, chronological timeline of relevant events in the patient's history must be provided to allow readers to understand the core elements of the case(s) such as the diagnostic methods, assessments, treatment, and follow-ups. 70e "strengths" and "limitations" were adequately mentioned in 22% and 6% of the case reports, respectively.Section 4 of the manuscript should evaluate the strengths of the report and summarize its implications on day-to-day clinical practice. 70A concise summary of any limitations of the case report will assist clinicians in reducing or eliminating similar problems in the management of their own patients. 70doubtedly, both biomedical researchers and clinicians consider that illustrations, photographs, and radiographs are important sources of information as they provide visual evidence to support the text that is presented. 71,72Due to the importance of images, the PRICE 2020 checklist has nine items directly related to the use of images in order to enhance the overall quality of the reporting. 7,70All 50 case reports included images but very few met the PRICE 2020 guidelines and several only partially fulfilled the criteria.
In this study, the case reports from Europe had higher scores followed by Asia and South America.However, due to a smaller number of samples, three continents (Africa, North America, and Journals with IFs were associated with higher quality scores than journals without an IF.This is likely due to the more stringent and rigorous review processes that such journals employ. 74 There was no significant difference in the scores between journals that adhered to the CARE guidelines and those that did not. A likely reason for this could be that few IF journals adhere to the CARE guidelines.Moreover, there was no difference between the publication time periods, suggesting that the quality of reporting had not improved over time.However.publications were limited to only five years (2015 to 2019) in this study, which could potentially mask a difference.
Two independent reviewers were involved in the selection and assessment of the included case reports.In order to provide a comprehensive overview, all case reports published in the field of dental traumatology, regardless of the journal (e.g., specialty versus nonspecialty, IF versus non-IF journal) were identified.This decreased the risk of both sample selection bias and reviewer bias.A potential limitation of this study is that only one database was used to conduct the search.In addition, only English language case reports published between 2015 and 2019 were considered, with the requirement that all case reports had to have been submitted to the journal before the release of the PRICE 2020 guidelines.In the future, a similar study will be conducted to assess the influence of the PRICE 2020 guidelines on the quality of case reports published after the introduction of these criteria.Different alphabetical superscripts indicate significant difference between the continent categories.

| CON CLUS ION
2 No significant difference. 3Due to a smaller number of samples-Africa, North America, and Oceania were excluded from the statistical analysis.Turkey lies within Europe and Asia and was, therefore, excluded from the analysis. 4Post hoc Tukey's test: No significant difference between Asia and Europe (p = .092);Asia and South America (p = .214).Significant difference present between Europe and South America (p = .004).
appraised the quality of case reports published between 2008 and 2018 using the CARE guidelines in the journals Dental Traumatology, European Archives of Paediatric Dentistry, International Journal of Clinical Pediatric Dentistry, International Journal of Paediatric Dentistry, Journal of Clinical Pediatric Dentistry, have endorsed the PRICE 2020 guidelines to date.Only two studies that have assessed the reporting quality of case reports related to dental trauma using the CARE guidelines have been published.One study 10 appraised the reporting quality of case reports published in Dental Traumatology, European Archives of Paediatric Dentistry, International Journal of Clinical Pediatric Dentistry, International Journal of Paediatric Dentistry, Journal of Clinical Pediatric Dentistry, and Pediatric Dentistry from 2008 to 2018.Another appraised the quality of case reports published in Dental Traumatology between 2001 and 2021. 11However, the reporting quality of case reports in the field of dental traumatology has not been evaluated using the PRICE 2020 guidelines.According to the findings of this study, none of the case reports met all the items in the PRICE 2020

Oceania) were excluded
from the statistical analysis.Most of the included case reports (n = 11) originated from Brazil and India.Tewari et al. 11 determined that 63 reports from Brazil were published in Dental Traumatology between 2002 and 2011 and 19 reports between 2011 and 2021.Liu et al. 73 described that among the top 10 countries in the world, Brazil ranked first with 480 reports related to traumatic dental injuries.

First author Country corresponding author(s) Year published Number of authors Journal adhered to CARE guideline Name of journal JCR® impact factor for the year in which the report was published
Characteristics of the included 50 case reports.
TA B L E 1 S no.

First author Country corresponding author(s) Year published Number of authors Journal adhered to CARE guideline Name of journal JCR® impact factor for the year in which the report was published
Introduction section of the Abstract should include a succinct S no.TA B L E 1 (Continued) TA B L E 2 Percentage of case reports that fulfilled each applicable item in the PRICE 2020 guidelines.
76ha et al. 75concluded that the IF may be a reasonable indicator of the quality of general medical journals.Ahmed Ali et al.76concluded that clinical trials published in journals with a higher IF were associated with

) Mean ± standard deviation Statistical test and p value
Scores of case reports assessed by the PRICE 2020 guidelines.Relationship between scores of the included case reports and characteristics of the papers.
tential to assist authors in planning and producing high-quality case reports, as well as to guide referees and journal editors when assessing manuscripts for publication.Due to the standardization of expectations through the PRICE 2020 guidelines, journal editors should consider endorsing the PRICE 2020 guidelines for case reports in endodontics and related disciplines.TA B L E 3 TA B L E 3 (Continued) TA B L E 4