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Topic:Prognosis
Prognosis in horses refers to the prediction of the likely outcome or course of a disease or injury in equine patients. It involves assessing various factors such as the nature and severity of the condition, the horse's overall health, and response to treatment. Prognostic evaluations help veterinarians and horse owners make informed decisions regarding treatment options, management strategies, and potential recovery. The process often incorporates clinical assessments, diagnostic tools, and historical data to estimate the chances of recovery or progression. This page compiles peer-reviewed research studies and scholarly articles that explore methodologies, factors influencing prognostic outcomes, and the implications of prognostic evaluations in equine veterinary practice.
Fracture of the distal sesamoid bone in horses: 17 cases (1982-1992). Medical records of 17 horses in which a distal sesamoid bone fracture was diagnosed between 1982 and 1992 were reviewed. There were 8 Standardbreds, 6 Quarter Horses, 2 Thoroughbreds, and 1 Arabian. Mean age was 4.7 years. A forelimb was affected in 15 horses, and a hind limb was affected in 2. All horses were lame, and most were grade III/V lame at the trot. In all horses, the diagnosis was confirmed by means of radiography. Five horses were treated with stall rest alone; 5 underwent neurectomy; 4 were treated with stall rest and corrective shoeing; and 1 was treated with stall rest and exter...
[Differentiated prognosis in the colicky horse]. In a retrospective study on 271 horses with colic the prediction about the outcome of the disease was made by a discriminating analysis. The best combination of quantitative prognostic parameters was capillary refill time, hematocrit, lactate and anion gap, with 90% correct predictions. In comparison with individually prognostic parameters, the combined prognosis constantly reached a higher percentage of correct predictions, the exact value resulting in 89%. Moreover, survival was better predictable than death.
Small intestinal herniation through the epiploic foramen: 53 cases (1987-1993). The incidence of epiploic entrapment of the small intestine in horses undergoing celiotomy for colic was 5%. The condition was more prevalent in older (mean 9.81 years) gelding and Thoroughbred horses. Preoperative peritoneal protein level was a good prognostic indicator as it was significantly greater in the nonsurvivor (39.4 +/- 5.10) group than in the survivor group (26.6 +/- 14.0) (P<0.05). Abdominal ultrasonography allowed earlier diagnosis and surgical intervention in nonpainful cases with inconclusive rectal findings. Surgery was completed in 46 horses and 44 horses recovered from anaes...
Heart murmurs in horses: determining their significance with echocardiography. Physiological flow murmurs occur frequently in horses and may be difficult to distinguish from murmurs associated with underlying cardiac disease. The significance of heart murmurs auscultated in horses is often difficult to determine if the horse is not exhibiting any clinical signs or if the signs, such as poor performance, are nonspecific. A complete echocardiographic examination (M-mode, 2-dimensional (2-D) and Doppler) provides an objective assessment of the severity of the horse's underlying cardiac disease. Valvular regurgitation and ventricular septal defects (VSDs) occur frequently an...
Kinetics, dose response, tachyphylaxis and cross-tachyphylaxis of vascular leakage induced by endotoxin, zymosan-activated plasma and platelet-activating factor in the horse. Vascular leakage induced by intradermal injection of endotoxin, zymosan-activated plasma (ZAP) and platelet-activating factor (PAF) was measured in nine Thoroughbreds using 125-iodine human serum albumin (125I-HSA) as a marker in the blood. ZAP and PAF produced dose-dependent increases in vascular permeability with the maximum occurring within the first 15 min after injection. The vascular leakage induced by endotoxin was also dose-dependent, but the maximum occurred 2 h after intradermal injection. Intradermal sites previously injected with endotoxin were refractory to a second injection of e...
Equine pleuropneumonia. Pleuropneumonia is a clinically important equine disease, predisposed by a number of identifiable factors. Successful management is largely dependent on early identification and prompt initiation of appropriate treatment strategies. Rapid resolution of the disease process is associated with appropriate treatment commenced within 48 h of the causative insult. Lower airway contamination by oropharyngeal organisms and subsequent extension into the pulmonary parenchyma results in respiratory dysfunction and systemic toxaemia. Acute disease is associated with the isolation of facultatively anaerobi...
Lag screw fixation of noncomminuted sagittal fractures of the proximal phalanx in racehorses: 59 cases (1973-1991). Medical records of 59 racehorses with noncomminuted midsagittal proximal phalanx fractures repaired by means of lag screw fixation between 1973 and 1991 were reviewed. Fractures were classified as short incomplete fractures (7), long incomplete fractures (32), complete fractures extending into the proximal interphalangeal joint (13), and complete fractures extending through the lateral cortex of the proximal phalanx (7). Time from fracture repair to first race following fracture repair, number of racing starts, and fastest race times before and after surgery were obtained from race records and...
Treatment of olecranon bursitis in horses: 10 cases (1986-1993). Medical records of 10 horses with olecranon bursitis were reviewed to examine treatments, evaluate a technique for en bloc resection of the bursa in standing horses, and determine outcome of the horses after treatment. Before admission, 6 horses had been treated by needle aspiration of fluid from the mass, followed by injection of corticosteroids. Subsequent treatment for 2 of these 6 horses included open drainage and packing of the cavity with gauze soaked in 7% iodine solution. None resolved after these treatments. After admission to the hospital, 5 horses were treated medically and 5 were t...
Surgical treatment of fractures of the tibial tuberosity in 6 adult horses. This paper describes the clinical and radiological features, surgical techniques used and results obtained in 6 horses with fractures of the tibial tuberosity. The horses were presented between 24 h and 8 weeks following injury. In all 6 cases, the fragments were displaced proximocranially and in 2 of these, there was comminution. Four were treated by open reduction and internal fixation using an AO/ASIF narrow dynamic compression plate and in 2 cases the fragments were removed. All horses returned to full athletic function and remained sound in follow-up times of 17-36 months. Implant removal...
Iridium-192 interstitial brachytherapy for equine periocular tumours: treatment results and prognostic factors in 115 horses. One hundred and fifteen horses with periocular tumours were treated with iridium-192 interstitial brachytherapy. Tumours included squamous cell carcinomas (n = 52) and sarcoids (n = 63). All horses were scheduled to receive 60 Gy (minimal tumour dose) given at a low dose rate (0.034 +/- 0.010 Gy/h). The mean and median follow-up times to last contact or death were 24 and 16 months, respectively. Chronic radiation reactions included palpebral fibrosis (10.4%), cataract (7.8%), keratitis and corneal ulceration (6.9%). Cosmetic changes included permanent epilation (21.7%) and hair dyspigmentation...
Development of a colic severity score for predicting the outcome of equine colic. Thirty-two physical examination and laboratory variables were recorded during examination of 165 horses admitted for acute abdominal disease. Univariate analyses were performed to determine which of the variables were significantly different between horses that lived or died. Stepwise logistic regression was performed to identify variables with the best predictive value. Four variables (heart rate, peritoneal fluid total protein concentration, blood lactate concentration, and abnormal mucous membrane) remained significant when entered into the model. Histograms for each significant variable we...
Digital flexor tendon lacerations in horses: 50 cases (1975-1990). The medical records of 50 horses examined because of lacerations of the tendon of the superficial or deep digital flexor muscle were reviewed to determine whether any injury or treatment factors could be associated with outcome. Median age of horses treated was 4.5 years (range, 1.5 years to 15 years), and the median follow-up time was 5 years (range, 1.5 to 16 years) after injury. Horses were considered to have survived if they were alive more than 1 year after injury. Twelve of 16 horses that had 1 or the other tendon transected survived; 13 of 16 horses that had both tendons transected surv...
[Radiologic follow-up examination of podotrochlosis]. X-rays of 205 horses having navicular disease and having been reexamined up to six times are evaluated. For this, the x-rays of each foreleg are evaluated in the dorsopalmar (Oxspring) and lateromedial view. Additionally to changes of the navicular bone, changes of the distal part of the toe are also assessed. Differences can be found in the radiographic process in view of the limitation of vascular foramina and cyst-like lesions. Vascular foramina with sclerotic rim grow less frequent than poorly defined ones and therefore allow for easier prognostication. Cyst-like lesions with sclerotic rim...
D-dimer improves the prognostic value of combined clinical and laboratory data in equine gastrointestinal colic. The discriminating ability of 15 parameters alone or in combinations, including results from analysis of plasma endotoxin, the Nycomed plasma D-Dimer test and phospholipase A2, were analyzed to predict morbidity and mortality in equine gastrointestinal colic. Endotoxaemia was a characteristic feature of the colic horses. The problem of adequately predicting nonsurvivors among colic horses required several parameters to be included in the logistic model: if the "classical parameters", (heart rate, respiratory rate, PCV, anion gap) were included in the model, addition of plasma D-dimer, phosphol...
Fibrinolytic activity in plasma from horses with gastrointestinal diseases: changes associated with diagnosis, surgery, and outcome. Plasma fibrinolytic activity was evaluated over 5 consecutive days in 59 horses admitted to the Large Animal Teaching Hospital with acute gastrointestinal diseases. Only horses hospitalized for at least 5 days were included in the study. Tissue plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1) were quantitated using standard chromogenic activity assays. Statistical analyses were performed using analysis of variance; differences were considered significant when P < or = .05. Activity of PAI-1, the primary endogenous inhibitor of fibrinolysis, was significantly incre...
Osteochondral fragmentation of the plantar/palmar proximal aspect of the proximal phalanx in racing horses. The clinical presentation and outcome of treatment is presented for 26 cases of osteochondral fragmentation of the plantar/palmar proximal aspect of the proximal phalanx. Twenty-three were racing Standardbreds and three were racing Thoroughbreds. The most common reason for presentation was an inability to run straight at high speed. Only eight horses presented for lameness, although on examination 19 were lame. A positive flexion test was recorded in 90% of affected fetlock joints and effusion in 48%. Arthroscopic fragment removal was performed on 23 occasions in 21 horses and arthrotomy in on...
Proximodorsal first phalanx osteochondral chip fragmentation in 336 horses. The results of arthroscopic surgery in the treatment of osteochondral fragmentation of the proximodorsal aspect of the first phalanx and the influence of other fetlock joint lesions on prognosis were evaluated in 336 horses. Horses were classified as: 1) returning to previous use at the same or higher class of performance; 2) returning to previous use (regardless of class of performance); or 3) failing to return to previous use. Ninety-six horses (29%) had fragmentation alone; 140 horses (42%) had fragmentation and additional fetlock lesions, and 100 horses (29%) underwent concurrent carpal ar...
Diagnostic techniques for identification and documentation of tendon and ligament injuries. Conventional clinical examination remains of medical and economic value for diagnosis of soft tissue injuries in the equine athlete. This procedure requires concentration and rigor to establish the diagnosis, and, if possible, some experience to better evaluate the prognosis. None of the new imaging techniques can replace the physical examination, but each may provide additional information. These sophisticated methods are bringing considerable progress in the knowledge of locomotor injuries in the horse and a tremendous improvement in our ability to diagnose precisely lamenesses and limitatio...
Superior check ligament desmotomy for treatment of superficial digital flexor tendonitis in thoroughbred and standardbred horses. Bilateral superior check ligament desmotomy was performed on 31 Thoroughbred and 17 Standardbred horses as the sole method of treatment for superficial digital flexor tendonitis. Horses resumed racing between 6 and 19 months after surgery. Horses that were able to compete in 5 or more races without injury to the tendon again were considered to have had a successful return to racing. Twenty-five Thoroughbreds were suitable for later study and 13 of these (52%) raced on 5 or more occasions. Fifteen Standardbreds were suitable for later study and 10 of these (66%) raced on 5 or more occasions. Wi...
[Prognostic parameters in equine colic]. A retrospective study was performed on 271 horses with colic referred to the I. Medizinische Tierklinik within a period of 2 years, to examine the prognostic value of different clinical and diagnostic laboratory parameters by Student's t-test and the Chi-quadratic test. The following quantitative parameters presented a highly significant prognostic value (P < 0.0001): capillary refill time, pulse rate, heart rate, respiratory rate, hematocrit, hemoglobin concentration, blood lactate, base excess and anion gap. The intensity of colic signs, the degree of disturbance of the patient's gen...
Surface oximetry for intraoperative assessment of colonic viability in horses. Surface oximetry was used to evaluate viability of the ascending colon in 60 horses with naturally occurring colonic volvulus or displacement. Tissue surface oxygen tension (PsO2) was measured on the serosal surface of the pelvic flexure after anatomic correction of the colonic obstruction. Horses with PsO2 > 20 mm of Hg were predicted to have viable colon; whereas, horses with PsO2 < or = 20 mm of Hg were predicted to have nonviable colon. Results of surface oximetry were compared with final outcome. For surface oximetry, sensitivity (ability to accurately identify colon that was nonvia...
Arthroscopic removal of a fragment from an intercondylar eminence fracture of the tibia in a two-year-old horse. A 2-year-old Standardbred colt was admitted because of lameness of the left hind limb. Physical examination revealed marked effusion of the left femoropatellar and femorotibial joints and grade IV/V lameness of the left hind limb. Radiography of the left stifle revealed a complete fracture of the medial tubercle of the intercondylar eminence of the tibia. Arthroscopy was used to provide diagnostic, therapeutic, and prognostic information. A cranial approach to the medial compartment of the femorotibial joint was performed. Manipulation of the medial tubercle revealed it to be unstable, but a d...
Ultrasonographic evaluation and long-term follow-up of flexor tendonitis/desmitis in the metacarpal/metatarsal region in Dutch warmblood horses and standardbred racehorses. Over a 2 year-period, the ultrasonographic localization and distribution of flexor tendinous and ligamentous injuries, the long-term follow-up, and the outcome were studied in 101 Dutch Warmblood horses (DW) with a mean age of 8.7 years and in 71 Standardbred racehorses (ST) with a mean age of 5.2 years. The ratio between forelimb and hind limb flexor tendonitis/desmitis in the DW-group was 4:1 and in the ST-group group 4:3. In the DW-group, tendonitis/desmitis of the suspensory ligament (32%), the superficial digital flexor tendon (29%), the distal carpal check ligament (17%) of the forelimb ...
Update on neonatal septicemia. Septicemia is the second most commonly diagnosed problem in the equine neonate, superseded only by the problem of inadequate transfer of maternal antibodies. This article reviews the factors that may put a foal at high risk for developing sepsis, the diagnostic tools used to identify these animals, some of the sequelae of sepsis, and the therapeutic modalities available to the clinician.
Blood cell deformability in horses with intestinal colic. Hematologic and rheologic variables were examined in a group of 13 horses with intestinal colic and a control group of 6 horses. All horses had been recently transported to the veterinary teaching hospital, and blood samples were obtained during initial examination. There were no significant differences in blood neutrophil count or plasma fibrinogen concentration between the groups, and PCV was significantly increased in horses with intestinal colic. Cell filterability was measured by passing uniform concentrations of blood, erythrocytes, and neutrophils through micropore filters. There were n...
Tetanus in the horse: a review of 20 cases (1970 to 1990). The case records of 20 horses with tetanus referred to the Ontario Veterinary College-Veterinary Teaching Hospital between 1970 and 1990 were reviewed. The fatality rate was 75%. There was a strong association with previous vaccination and survival (P = .03). Most of the animals had been injured an average of 9 days (range 2 to 21 days) prior to development of clinical signs. Hyperesthesia and prolapse of the third eyelid were the most common clinical signs. Treatment regimens varied during hospitalization; however, all horses received parenteral penicillin, tranquilizers, tetanus toxoid, and ...
Clinical use and characteristics of the corticosteroids. Corticosteroids possess potent anti-inflammatory activity and are commonly injected intra-articularly for local relief of inflammatory lesions in performance horses. However, the suppression of anabolic activity in the joint may lead to an increased rate of joint breakdown. Complications associated with intra-articular corticosteroid therapy include septic arthritis, which is usually due to inadvertent joint contamination at the time of corticosteroid injection, and steroid arthropathy, which is characterized by an accelerated rate of joint destruction and radiographic evidence of severe degen...
Articular fracture of the dorsoproximolateral aspect of the third metatarsal bone in five standardbred racehorses. Articular fracture of the dorsoproximolateral aspect of the third metatarsal bone (MT3) caused an acute onset of lameness in 5 horses; however, 3 of the horses had historical and radiographic or scintigraphic evidence of chronic tarsal and metatarsal disease before fracture. The pathogenesis of dorsoproximolateral fracture of MT3 remains unclear, but the fracture may occur as a result of the formation of abnormal bone in the proximal aspect of MT3. The prognosis for racing in horses with this fracture appears to be guarded.
Plasma endotoxin concentrations in clinically normal and potentially septic equine neonates. Plasma endotoxin concentrations were measured at 1 to 2 and 5 to 6 days of age in clinically normal foals and in potentially septic neonatal foals admitted to North Carolina State University's Veterinary Teaching Hospital for a variety of conditions. In 1 to 2 and 5 to 6 day old normal foals, median plasma endotoxin concentrations were 2.17 (range, 1.61-2.54; n = 6) and 2.89 (range, 2.61-3.50; n = 7) endotoxin units/mL (EU/mL), respectively. Median plasma endotoxin concentration in potentially septic foals with negative blood cultures or gram positive isolates (n = 8) was 2.73 (range, 0.59-4.0...
Desmitis of the accessory ligament of the deep digital flexor tendon in the horse: clinical and ultrasonographic features. A report of 24 cases. The clinical and ultrasonographic features of desmitis of the accessory ligament of the deep digital flexor tendon (carpal check ligament) are reported in a series of 24 horses. Lameness associated with the carpal check ligament especially was found in Warmblood riding horses ranging in age from 6 to 18 years with a mean age of 11.3 years. The most striking clinical feature was a firm, painful swelling medially and laterally in the proximal and/or mid metacarpal region, corresponding with the dorsoproximal-palmarodistal oblique direction of the carpal check ligament. Sonographically swelling o...
