FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Journal of veterinary internal medicine2017; 31(6); 1871-1876; doi: 10.1111/jvim.14822

Interobserver Variation in the Diagnosis of Neurologic Abnormalities in the Horse.

Abstract: The diagnosis of equine protozoal myeloencephalitis (EPM) relies heavily on the clinical examination. The accurate identification of neurologic signs during a clinical examination is critical to the interpretation of laboratory results. Objective: To investigate the level of agreement between board-certified veterinary internists when performing neurologic examinations in horses. Methods: Ninety-seven horses admitted to the Veterinary Teaching Hospital at The Ohio State University from December 1997 to June 1998. Methods: A prospective epidemiologic research design was used. Horses enrolled in the study were examined by the internist responsible for care of the horse, and later by an internist who was not aware of the presenting complaint or other patient history. Data were analyzed by descriptive statistics, and kappa (K) statistics were calculated to assess interobserver agreement. Results: Ninety-seven horses were enrolled in the study. Overall, examiners, also referred to as observers, agreed that 60/97 (61.9%) were clinically abnormal, 21/97 (21.6%) were clinically normal, and the status of 16/97 (16.5%) of horses was contested. There was complete agreement among the examiners with regard to cranial nerve signs and involuntary movements. Disagreement involving severity of clinical signs occurred in 31 horses, and 25 of those horses (80.6%) were considered either normal or mildly affected by the primary observer. When examining the results of all paired clinical examinations for 11 different categories, there was wide variability in the results. When examiners rated the presence or absence of any neurologic abnormalities, lameness, or ataxia, the agreement among observers was either good or excellent for 80% of horses. When assessing truncal sway, the agreement among observers was good or excellent for 60% of the horses. When examining the horses for asymmetry of deficits, agreement was either good or excellent for 40% of the horses. Agreement among observers was excellent or good for only 20% of the horses when assessing muscle atrophy, spasticity (hypermetria), and overall assessment of the severity of neurologic abnormalities. Conclusions: This study underscores the subjectivity of the neurologic examination and demonstrates a reasonable level of agreement that may be achieved when different clinicians examine the same horse.
Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Get Full Text
Publication Date: 2017-09-09 PubMed ID: 28887894PubMed Central: PMC5697190DOI: 10.1111/jvim.14822Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research focuses on measuring the level of agreement between different veterinary experts when diagnosing neurological conditions in horses, specifically equine protozoal myeloencephalitis (EPM). The results show that, although there is a fair level of agreement, the diagnostic process has a degree of subjectivity, which can result in variability in the diagnostic outcomes.

Methods and Sample

  • The study ran a prospective epidemiologic research design involving 97 horses admitted to The Ohio State University’s Veterinary Teaching Hospital between December 1997 and June 1998.
  • Each horse was examined by two internists – the one in charge of its care, and another who was not privy to the horse’s medical history or initial complaint. This process ensured that the second examination was unbiased and independent.
  • Data was analyzed using descriptive statistics, and kappa statistics were employed to assess the level of interobserver agreement.

Research Findings

  • Out of 97 horses, the examiners concurred that 60 horses were clinically abnormal, 21 were normal, and they disputed over the condition of 16 horses.
  • There was complete agreement when it came to diagnosing cranial nerve signs and involuntary movements.
  • The most disagreements stemmed from assessing the severity of clinical signs, with 31 horses causing a difference in opinion. In these cases, the majority were considered either normal or mildly affected by the first observer.

Interobserver Agreement Examination

  • The researchers found a varying degree of diagnostic agreement based on different clinical examinations. For instance, 80% of the horses received consistent diagnoses when the examiners were assessing the presence of any neurological abnormalities, lameness, or ataxia.
  • The degree of interobserver agreement went down to 60% when looking at truncal sway, and fell further to 40% when checking for asymmetry of deficits.
  • The lowest level of agreement was seen when evaluating muscle atrophy, spasticity or hypermetria, and overall severity of neurological abnormalities, with only 20% of the horses receiving consistent diagnoses.

Conclusions

  • The study highlighted the subjective nature of the neurological examination process in horses. It pointed out how different clinicians examining the same horse can reach different diagnostic outcomes.
  • Even though there is a notable variance in their findings, the study establishes a reasonable level of agreement that clinicians can potentially achieve when diagnosing horses for EPM or similar neurological conditions.

Cite This Article

APA
Saville WJA, Reed SM, Dubey JP, Granstrom DE, Morley PS, Hinchcliff KW, Kohn CW, Wittum TE, Workman JD. (2017). Interobserver Variation in the Diagnosis of Neurologic Abnormalities in the Horse. J Vet Intern Med, 31(6), 1871-1876. https://doi.org/10.1111/jvim.14822

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 31
Issue: 6
Pages: 1871-1876

Researcher Affiliations

Saville, W J A
  • Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
Reed, S M
  • Rood and Riddle Equine Hospital, Lexington, KY.
Dubey, J P
  • United Sates Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Animal Parasitic Diseases Laboratory, Beltsville, MD.
Granstrom, D E
  • American Veterinary Medical Association, Schaumburg, IL.
Morley, P S
  • Colorado School of Public Health, James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO.
Hinchcliff, K W
  • Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia.
Kohn, C W
  • Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
Wittum, T E
  • Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
Workman, J D
  • Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.

MeSH Terms

  • Animals
  • Ataxia / diagnosis
  • Ataxia / veterinary
  • Coccidiosis / veterinary
  • Dyskinesias / diagnosis
  • Dyskinesias / veterinary
  • Encephalomyelitis / diagnosis
  • Encephalomyelitis / parasitology
  • Encephalomyelitis / veterinary
  • Horse Diseases / diagnosis
  • Horses
  • Nervous System Diseases / diagnosis
  • Nervous System Diseases / veterinary
  • Observer Variation
  • Physical Examination / standards
  • Physical Examination / veterinary
  • Prospective Studies
  • Reproducibility of Results
  • Sarcocystosis / veterinary

Conflict of Interest Statement

Kenneth W. Hinchcliff serves as Co‐Editor in Chief for the Journal of Veterinary Internal Medicine. He was not involved in review of this manuscript.

References

This article includes 16 references
  1. Granstrom DE. Equine Protozoal Myeloencephalitis: Parasite biology, experimental disease, and laboratory diagnosis. International Equine Neurology Conference 1997;4–6.
  2. Morley PS, Saville WJA. Equine Protozoal Myeloencephalitis: What does a positive test mean?. Proc Am Assoc Equine Pract 1997;1–5.
  3. Duarte PC, Daft BM, Conrad PA, Packham AE, Saville WJ, MacKay RJ, Barr BC, Wilson WD, Ng T, Reed SM, Gardner IA. Evaluation and comparison of an indirect fluorescent antibody test for detection of antibodies to Sarcocystis neurona, using serum and cerebrospinal fluid of naturally and experimentally infected, and vaccinated horses.. J Parasitol 2004 Apr;90(2):379-86.
    pubmed: 15165063doi: 10.1645/ge-3263google scholar: lookup
  4. Reed SM, Howe DK, Morrow JK, Graves A, Yeargan MR, Johnson AL, MacKay RJ, Furr M, Saville WJ, Williams NM. Accurate antemortem diagnosis of equine protozoal myeloencephalitis (EPM) based on detecting intrathecal antibodies against Sarcocystis neurona using the SnSAG2 and SnSAG4/3 ELISAs.. J Vet Intern Med 2013 Sep-Oct;27(5):1193-200.
    pubmed: 24033423doi: 10.1111/jvim.12158google scholar: lookup
  5. Martin S, Meek A, Willeberg P. Epidemiologic Concepts. Veterinary Epidemiology Ames, IA: Iowa State University Press, 1987. p. 3–21.
  6. Mayhew IG. Measurements of the accuracy of clinical diagnoses of equine neurologic disease.. J Vet Intern Med 1991 Nov-Dec;5(6):332-4.
    pubmed: 1779426doi: 10.1111/j.1939-1676.1991.tb03146.xgoogle scholar: lookup
  7. Olsen E, Dunkel B, Barker WH, Finding EJ, Perkins JD, Witte TH, Yates LJ, Andersen PH, Baiker K, Piercy RJ. Rater agreement on gait assessment during neurologic examination of horses.. J Vet Intern Med 2014 Mar-Apr;28(2):630-8.
    pmc: PMC4857973pubmed: 24612411doi: 10.1111/jvim.12320google scholar: lookup
  8. Keegan KG, Dent EV, Wilson DA, Janicek J, Kramer J, Lacarrubba A, Walsh DM, Cassells MW, Esther TM, Schiltz P, Frees KE, Wilhite CL, Clark JM, Pollitt CC, Shaw R, Norris T. Repeatability of subjective evaluation of lameness in horses.. Equine Vet J 2010 Mar;42(2):92-7.
    pubmed: 20156242doi: 10.2746/042516409x479568google scholar: lookup
  9. Fuller CJ, Bladon BM, Driver AJ, Barr AR. The intra- and inter-assessor reliability of measurement of functional outcome by lameness scoring in horses.. Vet J 2006 Mar;171(2):281-6.
    pubmed: 16490710doi: 10.1016/j.tvjl.2004.10.012google scholar: lookup
  10. Hewetson M, Christley RM, Hunt ID, Voute LC. Investigations of the reliability of observational gait analysis for the assessment of lameness in horses.. Vet Rec 2006 Jun 24;158(25):852-7.
    pubmed: 16798953doi: 10.1136/vr.158.25.852google scholar: lookup
  11. van Kranen-Mastenbroek V, van Oostenbrugge R, Palmans L, Stevens A, Kingma H, Blanco C, Hasaart T, Vles J. Inter- and intra-observer agreement in the assessment of the quality of spontaneous movements in the newborn.. Brain Dev 1992 Sep;14(5):289-93.
    pubmed: 1456381doi: 10.1016/s0387-7604(12)80145-8google scholar: lookup
  12. Fleiss JL. Statistical methods for rates and proportions, 2nd ed. New York: John Wiley and Sons; 1981.
  13. Ehrhardt EE, Lowe JE. Observer variation in equine abdominal auscultation.. Equine Vet J 1990 May;22(3):182-5.
    pubmed: 2361506doi: 10.1111/j.2042-3306.1990.tb04244.xgoogle scholar: lookup
  14. Mayhew I. Large Animal Neurology, 1st ed. Philadelphia, PA: Lea & Febiger; 1989.
  15. van den Berge JH, Schouten HJ, Boomstra S, van Drunen Littel S, Braakman R. Interobserver agreement in assessment of ocular signs in coma.. J Neurol Neurosurg Psychiatry 1979 Dec;42(12):1163-8.
    pmc: PMC490434pubmed: 533856doi: 10.1136/jnnp.42.12.1163google scholar: lookup
  16. Wiener SL, Nathanson M. Frequent errors made in doing a neurologic exam.. Med Times 1978 Feb;106(2):109-11.
    pubmed: 634082

Citations

This article has been cited 4 times.
  1. van Spijk JN, Beckmann K, Wehrli Eser M, Stirn M, Steuer AE, Saleh L, Schoster A. Preliminary Investigation of Side Effects of Polymyxin B Administration in Hospitalized Horses. Antibiotics (Basel) 2023 May 5;12(5).
    doi: 10.3390/antibiotics12050854pubmed: 37237756google scholar: lookup
  2. van Spijk JN, Beckmann K, Wehrli Eser M, Boxler M, Stirn M, Rhyner T, Kaelin D, Saleh L, Schoster A. Adverse effects of polymyxin B administration to healthy horses. J Vet Intern Med 2022 Jul;36(4):1525-1534.
    doi: 10.1111/jvim.16470pubmed: 35801274google scholar: lookup
  3. Bedenice D, Johnson AL. Neurologic conditions in the sport horse. Anim Front 2022 Jun;12(3):37-44.
    doi: 10.1093/af/vfac036pubmed: 35711509google scholar: lookup
  4. Rijckaert J, Raes E, Buczinski S, Dumoulin M, Deprez P, Van Ham L, van Loon G, Pardon B. Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses. J Vet Intern Med 2020 Mar;34(2):964-971.
    doi: 10.1111/jvim.15699pubmed: 32030834google scholar: lookup
Subscribe to our newsletter
Join 99,780 horse owners like you who receive our email updates on horse health and nutrition.