Acute Medicine Journal is evolving, in a move to prioritize the publication of more randomized controlled trials (RCTs) and large prospective cohort studies, therefore accepting fewer case reports and retrospective studies. This trend reflects a fundamental shift towards stronger, more reliable and more generalisable scientific evidence in clinical research and practice.
Within the hierarchy of evidence in medical research, RCTs and prospective cohort studies feature higher because their design is aimed at minimizing bias and improving the validity of causal inferences. RCTs specifically can reduce the impact of confounding factors and the potential for bias through randomization, allocation concealment and blinding, making them the gold standard for testing effectiveness of simple and complex interventions^1,2. Prospective cohort studies, while observational, follow patients forward in time, allowing for robust evaluation of risk factors and disease development.
Retrospective design studies often opportunistically rely on past records, mostly collected for other reasons. The retrospective design can be efficient and low-cost, however is vulnerable to missing data, recall bias, and unmeasured confounding, often making it difficult to reliably infer causality³. Finally, while case reports provide detailed accounts of rare or novel medical conditions, they tend to lack generalizability and may be prone to anecdotal bias⁴.
The Journal’s new editorial rationale, by emphasizing RCTs and prospective cohorts studies, is committing to publish results that are more likely to inform clinical practice, guidelines development and health policy decisions, adopting an evidence-based medicine approach.
Finally, as the editorial team deals with a very significant backlog of submitted manuscripts, the selection process continues, and, invariably, acceptance rates are likely to decline, as the journal seeks to continue to focus its attention on enhancing its scientific output and impact on clinical practice.

References

1. Sibbaid B et al. Understanding controlled trials. Why are randomised controlled trials important? BMJ 1998;316:201
2. Braga LH et al. Randomized controlled trials - The what, when, how and why. Journal of Pediatric Urology 2025;21,397e404
3. Talari K et al. Retrospective studies - utility and caveats. J R Coll Physicians Edinb 2020 Dec;50(4):398-402
4. Freling TH et al. When poignant stories outweigh cold hard facts: A meta-analysis of the anecdotal bias. Organizational Behavior and Human Decision Processes 2020Sept;160:51-67