Acta veterinaria Scandinavica2015; 57; 69; doi: 10.1186/s13028-015-0160-9

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.

Curtis, L
·
Burford, JH
·
Thomas, JS
·
Curran, ML
·
Bayes, TC
·
England, GC
·
Freeman, SL

Abstract: 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 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.

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Publication Date: 2015-10-06 PubMed ID: 26444675PubMed Central: PMC4596518DOI: 10.1186/s13028-015-0160-9Google Scholar: Lookup

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Summary

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This research article focuses on a study that looked at how veterinary practitioners approach the primary evaluation of horses showing signs of abdominal pain. The study differentiates between non-critical and critical cases, providing novel insight into important indicators that can help early identification of serious cases, potentially improving the outcome and welfare of the horses.

Research Overview

If a horse shows signs of abdominal pain, early identification of critical cases is crucial to optimising its outcome and welfare. This study gathered data from 1016 evaluations by 167 veterinary practitioners in the United Kingdom over 13 months.
The cases were divided into non-critical ones, which positively responded to basic medical treatment, and critical ones, which required intensive medical treatment, surgical interventions, or which resulted in death or euthanasia.
The research aims to highlight the differences in initial presentations between non-critical and critical cases, something that most of the existing research focusing mainly on referral hospital populations overlooks.

Results

A various range of clinical signs were measured, including heart and respiratory rates, and gastrointestinal auscultation scores. A rectal examination was conducted in a considerable majority of cases.
Of the cases that met the study’s criteria, over three-quarters were non-critical, while less than a quarter were critical.
Behavioural severity scores of the clinical signs ranged from 0 to 17, with 70.4% of cases scoring from 0 to 6 and 29.6% scoring from 7 to 12.

Indicators of Critical Cases

The study used multivariable logistic regression to identify features in clinical presentations that were associated with critical cases.
Five key indicators were identified in predicting the severity of the case: the combined pain score, heart rate, capillary refill time longer than 2.5 seconds, weak pulse character, and absence of gut sounds in one or more quadrants. These variables had strong associations with critical cases and showed significant statistical relevance.
Pain, heart rate, gastrointestinal borborygmi (rumbling or gurgling noise made by the movement of fluid and gas in the intestines), and simple indicators of hypovolaemia (a decrease in the volume of blood plasma) were significant indicators of critical cases, even at the initial veterinary examination.

Conclusion

The study was the first to differentiate the primary presentation of non-critical and critical cases of abdominal pain in horses.
The results suggest that monitoring the identified significant clinical signs would be important in initial assessments and triage of horses presenting with colic (abdominal pain), potentially improving their diagnosis, treatment, and welfare.

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APA

Curtis L, Burford JH, Thomas JS, Curran ML, Bayes TC, England GC, Freeman SL. (2015). 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 Vet Scand, 57, 69. https://doi.org/10.1186/s13028-015-0160-9

Publication

Acta veterinaria Scandinavica

ISSN: 1751-0147

NlmUniqueID: 0370400

Country: England

Language: English

Volume: 57

Pages: 69

PII: 69

Researcher Affiliations

Curtis, Laila

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. lailacurtis@hotmail.co.uk.

Burford, John Harold

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. john.burford@nottingham.ac.uk.

Thomas, Jennifer Sara Marian

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. svyjt@exmail.nottingham.ac.uk.

Curran, Marise Linda

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. curran.marise@pdsa.org.uk.

Bayes, Tom Curtis

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. tom.bayes@live.com.

England, Gary Crane William

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. gary.england@nottingham.ac.uk.

Freeman, Sarah Louise

School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. sarah.freeman@nottingham.ac.uk.