Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study.
Abstract: The objective of this cross-sectional study was to compare the prevalence of selected clinical signs in laminitis cases and non-laminitic but lame controls to evaluate their capability to discriminate laminitis from other causes of lameness. Participating veterinary practitioners completed a checklist of laminitis-associated clinical signs identified by literature review. Cases were defined as horses/ponies with veterinary-diagnosed, clinically apparent laminitis; controls were horses/ponies with any lameness other than laminitis. Associations were tested by logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals, with veterinary practice as an a priori fixed effect. Multivariable analysis using graphical classification tree-based statistical models linked laminitis prevalence with specific combinations of clinical signs. Data were collected for 588 cases and 201 controls. Five clinical signs had a difference in prevalence of greater than +50 per cent: 'reluctance to walk' (OR 4.4), 'short, stilted gait at walk' (OR 9.4), 'difficulty turning' (OR 16.9), 'shifting weight' (OR 17.7) and 'increased digital pulse' (OR 13.2) (all P<0.001). 'Bilateral forelimb lameness' was the best discriminator; 92 per cent of animals with this clinical sign had laminitis (OR 40.5, P<0.001). If, in addition, horses/ponies had an 'increased digital pulse', 99 per cent were identified as laminitis. 'Presence of a flat/convex sole' also significantly enhanced clinical diagnosis discrimination (OR 15.5, P<0.001). This is the first epidemiological laminitis study to use decision-tree analysis, providing the first evidence base for evaluating clinical signs to differentially diagnose laminitis from other causes of lameness. Improved evaluation of the clinical signs displayed by laminitic animals examined by first-opinion practitioners will lead to equine welfare improvements.
British Veterinary Association.
Publication Date: 2016-03-11 PubMed ID: 26969668DOI: 10.1136/vr.103588Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
- Clinical Examination
- Clinical Pathology
- Clinical Signs
- Clinical Study
- Diagnosis
- Diagnostic Technique
- Disease Diagnosis
- Disease Management
- Disease Treatment
- Epidemiology
- Equine Diseases
- Equine Health
- Horses
- Lameness
- Regression Analysis
- Veterinary Care
- Veterinary Medicine
- Veterinary Practice
- Veterinary Research
- Veterinary Science
Summary
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This research article presents a cross-sectional study examining the occurrence of specific clinical signs in horses and ponies with laminitis versus those showing other causes of lameness. The goal was to refine diagnostic techniques for laminitis by comparing symptom prevalence, with some symptoms showing a large discrepancy between the two groups.
Objective and Methodology
- The main aim of the study was to evaluate the ability of certain clinical signs to distinguish between equine laminitis — a serious condition affecting the feet of horses/ponies — and other causes of lameness.
- Veterinary practitioners evaluated a list of laminitis-related clinical signs identified through a literature review.
- Laminitis cases were identified in horses/ponies where laminitis was diagnosed and visually evident, while the control group comprised animals with any lameness not attributable to laminitis.
- Associations between symptoms and conditions were analysed using logistic regression, with odds ratios (ORs) and 95% confidence intervals adjusted for the effect of different veterinary practices.
Results and Significance
- Data collection involved 588 cases of laminitis and 201 controls.
- Five clinical signs showed a greater than +50 per cent differential prevalence between laminitis cases and controls: ‘reluctance to walk’, ‘short, stilted gait at walk’, ‘difficulty turning’, ‘shifting weight’ and ‘increased digital pulse’.
- Of these, ‘bilateral forelimb lameness’ was the best discriminator, occurring in 92 per cent of laminitis cases (OR 40.5, P<0.001).
- In animals displaying both ‘bilateral forelimb lameness’ and an ‘increased digital pulse’, 99 per cent were diagnosed with laminitis.
- The presence of a ‘flat/convex sole’ was also a significant indicator, enhancing the clinical diagnostic discrimination significantly.
Conclusion
- This research is the first to use decision-tree analysis for epidemiological studies on laminitis, providing a new evidence-based approach to diagnosing this condition in horses/ponies.
- Refining the evaluation of clinical signs in animals suffering from laminitis promises to lead to improvements in equine welfare through more rapid and accurate diagnoses.
Cite This Article
APA
Wylie CE, Shaw DJ, Verheyen KL, Newton JR.
(2016).
Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study.
Vet Rec, 178(17), 420.
https://doi.org/10.1136/vr.103588 Publication
Researcher Affiliations
- Epidemiology Department, Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, UK Rossdales Equine Hospital, Cotton End Road, Exning, Newmarket, Suffolk, UK.
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian, UK.
- Veterinary Epidemiology, Economics and Public Health Group, Department of Production and Population Health, Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, UK.
- Epidemiology Department, Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, UK.
MeSH Terms
- Animals
- Case-Control Studies
- Cross-Sectional Studies
- Decision Trees
- Diagnosis, Differential
- Foot Diseases / diagnosis
- Foot Diseases / veterinary
- Hoof and Claw
- Horse Diseases / diagnosis
- Horses
- Lameness, Animal / etiology
Citations
This article has been cited 4 times.- Dancer AMM, Díez-León M, Bizley JK, Burn CC. Pet Owner Perception of Ferret Boredom and Consequences for Housing, Husbandry, and Environmental Enrichment.. Animals (Basel) 2022 Nov 23;12(23).
- Meier A, McGree J, Klee R, Preuß J, Reiche D, de Laat M, Sillence M. The application of a new laminitis scoring method to model the rate and pattern of improvement from equine endocrinopathic laminitis in a clinical setting.. BMC Vet Res 2021 Jan 7;17(1):16.
- Meier A, de Laat M, Pollitt C, Walsh D, McGree J, Reiche DB, von Salis-Soglio M, Wells-Smith L, Mengeler U, Mesa Salas D, Droegemueller S, Sillence MN. A "modified Obel" method for the severity scoring of (endocrinopathic) equine laminitis.. PeerJ 2019;7:e7084.
- de Laat MA, Sillence MN, Reiche DB. Phenotypic, hormonal, and clinical characteristics of equine endocrinopathic laminitis.. J Vet Intern Med 2019 May;33(3):1456-1463.
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