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

Abstract

BackgroundThe 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.ResultsData 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 < 0.001, 95 % CI 1.04–1.08), capillary refill time >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).ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13028-015-0160-9) contains supplementary material, which is available to authorized users.

Horse owners’ knowledge, and opinions on recognising colic in the horse

“…The understanding of colic being a gastrointestinal malfunction is consistent with the study by Scantlebury et al . Although colic is primarily caused by gastrointestinal issues, it refers to abdominal pain, caused by diseases of any abdominal organs, and there may be a wide range of underlying causes . This misconception of a single disease may again relate back to issues around recognising different signs of colic.…”

“…A significant number also stated that if their horse had colic, they would assess some clinical parameters, specifically gut sounds (75%), respiration rate (65%) and heart rate (54%) before they contacted anyone else. These parameters can be important indicators of the severity of the condition . The findings of this study demonstrate owners’ willingness to be actively involved in the assessment of their horse’s health, but that there are issues with how their assessments may be interpreted.…”

Fifty years of colic surgery

“…Results of one study identified some referring veterinarians whose surgical colic cases had a higher risk of intra‐operative death than others , possibly because of delays in referral. More encouraging was the finding in a recent study that 96% of horses that had surgery for colic had one visit by a veterinarian at the farm , which would suggest that referring veterinarians can accurately identify those cases that should undergo surgery and could refer them promptly.…”

“…Colic episodes per 100 horse/equid years can range from 3.5 to 10.6 or as a percentage of equids at risk from 2.8 to 2.9% according to farm‐based studies or owner reported data. In the general equine population, approximately 1.4–17.5% of horses with colic require or undergo surgery . Improvements in surgical outcomes in horses with the most severe forms of colic have been attributed to early referral, advances in surgery, safer anaesthesia and improved aftercare .…”

Efeito da eletroacupuntura sobre a motilidade e trânsito intestinal de equinos

“…A outra teoria, mais encontrada e citada, defende o estímulo vagal proporcionado pela acupuntura, o que aumenta a atividade parassimpática, consequentemente, estimulando a motilidade intestinal(FANG et al, 2017;OKADA et al, 2019). Este provavelmente foi o meio pelo qual se obteve aumento dos sons intestinais observados no presente estudo.Sabe-se que os sons intestinais indicam aumento da motilidade intestinal(BOSCAN et al, 2006;GERRING;HUNT, 1986;LIPPOLD;HILDEBRAND;STRAUB, 2004) e são considerados como um bom parâmetro para avaliação da condição da motilidade intestinal de equinos com cólica(CURTIS et al, 2015;JENNINGS et al, 2014). A auscultação intestinal é amplamente utilizada nas mais diversas vertentes da clínica equina e na pesquisa envolvendo equinos, desde avaliação da influência de dietas e fármacos na motilidade intestinal até a avaliação de dor(CARREGARO et al, 2014;DONNELLAN et al, 2013;GIUSTO;PAGLIARA;GANDINI, 2014;SALCICCIA et al, 2019;SANO et al, 2011;TAFFAREL et al, 2015).…”