title: In support of clinical case reports: a system of causality assessment.
abstract: The usefulness of clinical research depends on an assessment of causality. This assessment determines what constitutes clinical evidence. Case reports are an example of evidence that is frequently overlooked because it is believed they cannot address causal links between treatment and outcomes. This may be a mistake. Clarity on the topic of causality and its assessment will be of benefit for researchers and clinicians. This article outlines an overall system of causality and causality assessment. The system proposed involves two dimensions: horizontal and vertical; each of these dimensions consists of three different types of causality and three corresponding types of causality assessment. Included in this system are diverse forms of case causality illustrated with examples from everyday life and clinical medicine. Assessing case causality can complement conventional clinical research in an era of personalized medicine.
authors.affiliation: Helmut Kiene, Dr med, is director of Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Kiene
authors.affiliation: Harald J. Hamre, Dr med, is research scientist at the Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke, Germany.
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hamre
authors.affiliation: Gunver S. Kienle, Dr med, is research scientist at the Institute for Applied Epistemology and Medical Methodology at the University of Witten/Herdecke, Germany.
authors.forename: Gunver S
authors.initials: GS
authors.lastname: Kienle
keywords: Case reports; case causality; causality assessment; causality system; cognition-based medicine; evidence-based medicine; expanded evidence; review