Every manuscript that passes an initial scope and similarity check is sent for double-blind peer review: reviewers are not told who the authors are, and authors are not told who reviewed.

The process

1. Editorial screening - scope, completeness, ethics statements and text similarity. Typically within one week.
2. Review - at least two independent reviewers with relevant clinical expertise.
3. Decision - accept, minor revision, major revision, or reject, made by a handling editor on the basis of the reviews.
4. Revision - authors respond point by point. Major revisions usually return to the original reviewers.
5. Publication - accepted articles are copy-edited, typeset and published in the current issue.

What reviewers are asked

Whether the case is worth reporting, whether the clinical account is complete and internally consistent, whether the conclusions follow from what is described, whether the literature is fairly represented, and whether consent and ethics are properly documented.

Appeals

Authors may appeal a decision once, in writing, addressing the specific reviewer points. Appeals are handled by an editor who was not involved in the original decision.