Title: Revised Surgical CAse REport (SCARE) Guideline: An Update for the Age of Artificial Intelligence
ABSTRACT
Artificial intelligence (AI) is rapidly transforming healthcare and scientific publishing. Reporting guidelines need to be updated to consider this advance. The SCARE Guideline 2025 update introduces a new AI-focused domain to promote transparency, reproducibility, and ethical integrity in surgical case reports SCAREs) involving AI.
A Delphi consensus exercise was conducted to update the SCARE guidelines. A panel of 49 surgical and scientific experts was invited to rate proposed new items. In round 1, participants scored each item on a nine-point Likert scale and provided feedback. Items not meeting consensus were revised or discarded.
A 94% response rate occurred amongst participants (46/49) in the first round. Ratings were analyzed for agreement levels, and consensus was reached on all six proposed AI-related items. A revised SCARE checklist is presented, which incorporates these new AI-related items. Authors are now expected to disclose AI involvement in patient care and manuscript preparation, as exemplified by this article.
The SCARE 2025 guideline provides an up-to-date framework for SCAREs in the era of AI. Through a robust consensus process, we have added specific reporting criteria for AI to ensure that any use of AI in a case report is documented, explained, and discussed concerning bias and ethics. This update will help maintain the quality, transparency, and clinical relevance of case reports, ultimately improving their educational value and trustworthiness for the surgical community.
Keywords: SCARE guideline update, Artificial intelligence in surgery, Delphi consensus process, AI transparency and ethics, AI reporting standards
Authors & Designations:
- Riaz A. Agha, MBBS, FRCS – University of Oxford, UK
- Ahmed Kerwan, MD – Harvard Medical School, USA
- Ahmed Al‑Jabir, PhD – University College London, UK
- Catrin Sohrabi, MD – Royal Free London NHS Foundation
- Ginimol Mathew, MD – Royal Free London NHS Foundation
- Thomas Franchi, MD – Royal Free London NHS Foundation
- Maria Nicola, MD – Royal Free London NHS Foundation
- Maliha Agha, MD – University of Oxford/Surgical trainee
- SCARE Group (2025)
Source: Premier Journal of Science (2025), Article ID pjs‑25‑932.
APA Citation:
Agha, R. A., Kerwan, A., Al‑Jabir, A., Sohrabi, C., Mathew, G., Franchi, T., Nicola, M., Agha, M., & SCARE Group. (2025). Revised Surgical CAse REport (SCARE) Guideline: An Update for the Age of Artificial Intelligence. Premier Journal of Science, Article pjs‑25‑932. https://doi.org/10.70389/PJS.100079
🔍 Background & Objective
As artificial intelligence (AI) becomes integral to healthcare, reporting standards must evolve accordingly. This paper updates the Surgical CAse REport (SCARE) guideline, originally launched in 2016 and last revised in 2023, by introducing a new AI-specific domain (items 5a–5f) to ensure transparency and ethical accountability in surgical case reports involving AI.
🧠 Methodology
A Delphi consensus process was conducted with a panel of 49 international experts in surgery, medicine, and scientific publication. With a robust 94% response rate (46/49), the panel scored each proposed AI-related item on a 9-point Likert scale. Consensus (≥70% agreement) was achieved for all six items, as detailed in the revised checklist.
📈 Key Results
- Six AI-related checklist items were approved and integrated:
- AI usage declaration, tool configuration, data inputs, human oversight, bias/ethics, and reproducibility/transparency.
- Template now mandates authors to report AI involvement in both clinical case management and manuscript preparation.
🏆 Significance & Impact
The SCARE 2025 guideline brings the standard in surgical case reporting fully into the AI era. By requiring specific disclosures on:
- AI systems used,
- their purpose and validation,
- bias and ethical considerations,
- and reproducibility—the update ensures clarity and trustworthiness in scientific communication.
Transparency is further modeled by the authors, who disclosed using generative AI for manuscript editing.
📌 Original Abstract Excerpt
“The SCARE Guideline 2025 update introduces a new AI-focused domain to promote transparency, reproducibility, and ethical integrity in surgical case reports … consensus was reached on all six proposed AI-related items … authors are now expected to disclose AI involvement … exemplified by this article.”
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