Objectives To 1) determine the normal range for Shock Index (SI) [defined as heart rate (HR)/systolic blood pressure (SBP)], in healthy dogs, and 2) compare SI in healthy dogs with dogs presenting to the emergency room (ER) deemed to be in or not in a state of shock. Design Prospective study. Animals 68 clinically normal dogs,,18 dogs that were presented to the ER deemed to be in shock and 19 dogs presenting to the ER not deemed to be in shock. Setting University teaching hospital. Interventions Peripheral or central venous blood sampling. Measurements and Main Results Heart rate and SBP were recorded on simulated presentation (healthy dogs), and emergency presentations for both dogs deemed to be in shock and dogs not deemed in shock. Dogs in shock had a median SI of 1.37 (0.87–3.13), which was significantly higher than both other groups; dogs not deemed in shock had median SI 0.73 (0.56–1.20), P<0.0001 and healthy dogs had median SI 0.78 (0.37–1.30) P<0.0001), respectively. Receiver operator characteristic curve analysis suggested a SI cut-off of 1.0, yielding an area under the receiver operator characteristic (AUROC) of 0.89 (Specificity (Sp) 89, Sensitivity (Sn) 90) when comparing dogs deemed in shock with healthy dogs, and 0.92 (Sp 95, Sn 89) when comparing dogs in shock with to dogs not deemed in shock. Conclusions The SI is an easy and non-invasive patient parameter that is higher in dogs that are deemed to be in shock than both healthy dogs and dogs presented as emergencies but not deemed to be in a state of shock. The measurement of SI may have some benefit in clinical assessment of emergency patients.

Survival for dogs with ATh or ATE is reported to be between 50% and 60%. Dogs that present with chronic clinical signs appear to have a better prognosis than those who are acutely affected or those who are severely affected.

Introduction: Acute heart failure is significant source of morbidity, mortality, and resource utilization in both children and adults. Previous studies suggest there is increased morbidity, mortality, and cost in pediatric compared to adult hospitalizations. However, there are few data on the differences in heart failure prevalence or outcomes in the emergency department (ED). Hypothesis: Pediatric heart failure related (HFR) ED visits are more commonly associated with congenital heart disease (CHD), have increased charges, and more frequent hospitalizations compared to adult HFR ED visits. Methods: A retrospective analysis of the Nationwide Emergency Department Sample from 2010 was performed to assess HFR ED visits in pediatric (age # 18 years) and adult (age O 18 years) patients and compare factors associated with hospital admission, morbidity, mortality, and resource utilization. Results: 982,525 adult and 1,299 pediatric HFR ED visits were identified. Pediatric HFR ED visits were more likely at a metropolitan teaching hospital (72.9% vs 38.9%; p!0.001) and have a primary payer of Medicaid (62.8% vs 8.6%; p!0.001) compared to adult HFR ED visits. CHD was more common (42% vs 0.4%; p! 0.001) and cardiomyopathy was similar (14% vs 12%; p50.160) in pediatric vs adult HFR ED visits. Comorbidities of renal failure (17% vs 5%; p!0.001) and arrhythmias (37% vs 15%; p!0.001) were more common among adults; pulmonary hypertension was more common among pediatric patients (12% vs 9%; p50.002). Adults were more likely to be admitted to the hospital (72% vs 60%; p!0.001) and incur greater charges in the ED (median $1,611 interquartile range [IQR] $1,011 to $2,554 vs median $1,460, IQR $861 to $2,038; p!0.001) compared to pediatric patients, but pediatric patients incurred more charges if admitted to the hospital (median $38,400, IQR $15,202 to $116,327 vs median $25,630, IQR $14,318 to $49,012; p! 0.001). The overall hospital mortality was similar among all admissions (5.6% pediatric vs 5.0% adults; p50.28) but trended toward increased mortality in pediatric cardiomyopathy vs adult cardiomyopathy patients (7.6% vs 4.4%; p50.06). Conclusions: Pediatric and adult HFR ED visits usually lead to hospital admission and are frequently associated with comorbidities. Pediatric patients were more likely to be cared for at metropolitan teaching hospitals, have CHD, and less likely to be admitted to the hospital. However, when pediatric patents were admitted to the hospital, they incurred greater charges compared to adults. Further study is needed to improve care and resource utilization in this complex population.