Prospective study of the primary evaluation of 1016 horses with clinical signs of abdominal pain by veterinary practitioners, and the differentiation of critical and non-critical cases

Acta Veterinaria Scandinavica

Laila Curtis¹  John Harold Burford¹  Jennifer Sara Marian Thomas¹  Marise Linda Curran¹  Tom Curtis Bayes¹  Gary Crane William England¹  Sarah Louise Freeman¹ 

[1] School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough LE12 5RD, LE, UK

关键词: Outcome;    Critical;    Evaluation;    Colic;    Horse;   

Others  :  1228600
DOI  :  10.1186/s13028-015-0160-9

 received in 2015-05-30, accepted in 2015-08-07,  发布年份 2015

【 摘 要 】

Background

The majority of research on the evaluation of horses with colic is focused on referral hospital populations. Early identification of critical cases is important to optimise outcome and welfare. The aim of this prospective study was to survey the primary evaluation of horses with clinical signs of abdominal pain by veterinary practitioners, and compare the initial presentation of critical and non-critical cases.

Results

Data from 1016 primary evaluations of horses presenting with clinical signs of colic were submitted by 167 veterinary practitioners across the United Kingdom over a 13 month period. The mean age of the study population was 13.5 years (median 12.0, range 0–42). Mean heart rate on primary presentation was 47 beats/min (median 44, range 18–125), mean respiratory rate was 20 breaths/min (median 16, range 6–100), and median gastrointestinal auscultation score (0–12, minimum–maximum) was 5 (range 0–12). Clinical signs assessed using a behavioural severity score (0–17, minimum–maximum), were between 0 and 6 in 70.4 % of cases, and 7–12 for 29.6 % of cases. Rectal examination was performed in 73.8 % of cases. Cases that responded positively to simple medical treatment were categorised retrospectively as ‘non-critical’; cases that required intensive medical treatment, surgical intervention, died or were euthanased were categorised as ‘critical’. Eight-hundred-and-twenty-two cases met these criteria; 76.4 % were ‘non-critical’ and 23.6 % were ‘critical’. Multivariable logistic regression was used to identify features of the clinical presentation associated with critical cases. Five variables were retained in the final multivariable model: combined pain score: (OR 1.19, P < 0.001, 95 % CI 1.09–1.30), heart rate (OR 1.06, P < 0.001, 95 % CI 1.04–1.08), capillary refill time >2.5 s (OR 3.21, P = 0.046, 95 % CI 1.023–10.09), weak pulse character (OR 2.90, P = 0.004, 95 % CI 1.39–5.99) and absence of gut sounds in ≥1 quadrant (OR 3.65, P < 0.001, 95 % CI 2.08–6.41).

Conclusions

This is the first study comparing the primary presentation of critical and non-critical cases of abdominal pain. Pain, heart rate, gastrointestinal borborygmi and simple indicators of hypovolaemia were significant indicators of critical cases, even at the primary veterinary examination, and should be considered essential components of the initial assessment and triage of horses presenting with colic.

【 授权许可】

   
2015 Curtis et al.

【 参考文献 】

• [1]Tinker MK, White NA, Lessard P, Thatcher CD, Pelzer KD, Davis B et al.. Prospective study of equine colic incidence and mortality. Equine Vet J. 1997; 29(6):448-453.
• [2]Ireland JL, Clegg PD, McGowan CM, Platt L, Pinchbeck GL. Factors associated with mortality of geriatric horses in the United Kingdom. Prev Vet Med. 2011; 101(3):204-218.
• [3]Fischer AT. Advances in diagnostic techniques for horses with colic. Vet Clin N Am Eq Prac. 1997; 13(2):203-219.
• [4]Canonico M, Plu-Bureau G, Lowe GDO, Scarabin P-Y. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008; 336(7655):1227-1231.
• [5]Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P et al.. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-926.
• [6]Proudman CJ. A two year, prospective survey of equine colic in general practice. Equine Vet J. 1992; 24(2):90-93.
• [7]Hillyer MH, Mair TS. Recurrent colic in the mature horse: a retrospective review of 58 cases. Equine Vet J. 1997; 29(6):421-424.
• [8]Hillyer MH, Taylor FGR, Proudman CJ, Edwards GB, Smith JE, French NP. Case control study to identify risk factors for simple colonic obstruction and distension colic in horses. Equine Vet J. 2002; 34(5):455-463.
• [9]Hillyer MH, Taylor FGR, French NP. A cross-sectional study of colic in horses on Thoroughbred training premises in the British Isles in 1997. Equine Vet J. 2001; 33(4):380-385.
• [10]Goncalves S, Leblond A, Drogoul C, Julliand V. Using feces characteristics as a criterion for the diagnosis of colic in the horse: a clinical review of 207 cases. Revue Med Vet. 2006; 157(1):3-10.
• [11]Scantlebury CE, Archer DC, Proudman CJ, Pinchbeck GL. Recurrent colic in the horse: incidence and risk factors for recurrence in the general practice population. Equine Vet J. 2011; 43:81-88.
• [12]Traub-Dargatz J, Salman M, Voss J. Medical problems of adult horses, as ranked by equine practitioners. JAVMA. 1991; 198(10):1745-1747.
• [13]Issaoui L. Survey of colic cases seen in first-opinion practice. Vet Rec. 2013; 172(24):643-644.
• [14]Issaoui L. Equine practitioner participation required for colic survey. Vet Rec. 2012; 171(17):430.
• [15]Iarossi G. The power of survey design: a user’s guide for managing surveys, interpreting results, and influencing respondents. Washington DC: The World Bank. 2006. https://openknowledge.worldbank.org/handle/10986/6975. Accessed 31 May 2015.
• [16]Price J, Catriona S, Welsh EM, Waran NK. Preliminary evaluation of a behaviour-based system for assessment of post-operative pain in horses following arthroscopic surgery. Vet Anaesth Analg. 2003; 30(3):124-137.
• [17]Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 1: short-term survival following a single laparotomy. Equine Vet J. 2005; 37(4):296-302.
• [18]Sutton GA, Dahan R, Turner D, Paltiel O. A behaviour-based pain scale for horses with acute colic: scale construction. Vet J. 2013; 196(3):394-401.
• [19]Sasaki N, Murata A, Lee I, Yamada H. Evaluation of equine cecal motility by ausculation, ultrasonography and electrointestinography after jejunocecostomy. Res Vet Sci. 2008; 84(2):305-310.
• [20]Hillyer MH, Taylor FG, Proudman CJ, Edwards GB, Smith JE, French NP. Case control study to identify risk factors for simple colonic obstruction and distension colic in horses. Equine Vet J. 2002; 34(5):455-463.
• [21]Traub-Dargatz JL, Kopral CA, Seitzinger AH, Garber LP, Forde K, White NA. Estimate of the national incidence of and operation-level risk factors for colic among horses in the United States, spring 1998 to spring 1999. JAVMA. 2001; 219(1):67-71.
• [22]Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000; 342(25):1887-1892.
• [23]Mair TS, Mellor D. BEVA evidence based medicine study of analgesia for colic: preliminary findings. 8th International Colic Research Symposium, Quebec; 2005.
• [24]Hallowell GD. Retrospective study assessing efficacy of treatment of large colonic impactions. Equine Vet J. 2008; 40(4):411-413.
• [25]Furr MO, Lessard P, White NA. Development of a colic severity score for predicting the outcome of equine colic. Vet Surg. 1995; 24(2):97-101.
• [26]Thoefner MB, Ersboll AK, Jensen AL, Hesselholt M. Factor analysis of the interrelationships between clinical variables in horses with colic. Prev Vet Med. 2001; 48(3):201-214.
• [27]Van der Linden MA, Laffont CM, van Oldruitenborgh-Oosterbaan MMS. Prognosis in equine medical and surgical colic. J Vet Intern Med. 2003; 17(3):343-348.
• [28]Pritchett LC, Ulibarri C, Roberts MC, Schneider RK, Sellon DC. Identification of potential physiological and behavioral indicators of postoperative pain in horses after exploratory celiotomy for colic. Appl Anim Behav Sci. 2003; 80(1):31-43.
• [29]Puotunen-Reinert A. Study of variables commonly used in examination of equine colic cases to assess prognostic value. Equine Vet J. 1986; 18(4):275-277.
• [30]Reeves MJ, Curtis CR, Salman MD, Hilbert BJ. Prognosis in equine colic patients using multivariable analysis. Can J Vet Res. 1989; 53(1):87-94.
• [31]Ihler CF, Venger JL, Skjerve E. Evaluation of clinical and laboratory variables as prognostic indicators in hospitalised gastrointestinal colic horses. Acta Vet Scand. 2004; 45(1):109-118. BioMed Central Full Text
• [32]Proudman CJ, Dugdale AHA, Senior JM, Edwards GB, Smith JE, Leuwer ML et al.. Pre-operative and anaesthesia-related risk factors for mortality in equine colic cases. Vet J. 2006; 171(1):89-97.
• [33]Reeves MJ, Curtis CR, Salman MD, Stashak TS, Reif JS. Validation of logistic-regression models used in the assessment of prognosis and the need for surgery in equine colic patients. Prev Vet Med. 1992; 13(3):155-172.
• [34]Grosche A, Schrodl W, Schusser GF. Specific parameters of blood and peritoneal fluid to indicate the severity of intestinal ischemia in colic horses. Tierarztl Prax G N. 2006; 34(6):387-396.
• [35]Van den Boom R, Butler CM, Van Oldruitenborgh-Oosterbaan MMS. The usability of peritoneal lactate concentration as a prognostic marker in horses with severe colic admitted to a veterinary teaching hospital. Equine Vet Ed. 2010; 22(8):420-425.
• [36]Grulke S, Olle E, Detilleux J, Gangl N, Caudron I, Serteyn D. Determination of a gravity and shock score for prognosis in equine surgical colic. J Vet Med. 2001; 48(8):465-473.
• [37]Parry BW, Gay CC, Anderson GA. Assessment of the necessity for surgical intervention in cases of equine colic: a retrospective study. Equine Vet J. 1983; 15(3):216-221.
• [38]White NA, Elward A, Moga KS, Ward DL, Sampson DM. Use of web-based data collection to evaluate analgesic administration and the decision for surgery in horses with colic. Equine Vet J. 2005; 37(4):347-350.