Monthly Journal Round-Up - January 2018

Thanks as always to Lara Brunori DVM CertAVP MRCVS

Clinical studies:

Retrospective:

  • Binvel, M. et al. (2017) ‘Endoscopic and surgical removal of oesophageal and gastric fishhook foreign bodies in 33 animals’. Journal of Small Animal Practice,    doi: 10.1111/jsap.12794 (Early view)
  • Klainbart, S., et al. (2017) ‘Retrospective evaluation of 140 dogs involved in road traffic accidents’. Veterinary Record doi: 10.1136/vr.104293 (Early view)
  • Hernon, T. et al (2018) ‘A retrospective study of feline trauma patients admitted to a referral centre’. Journal of Small Animal Practice, doi: 10.1111/jsap.12815  (Early view)
  • Lennon, E. M. et  al. (2018) ‘Urine sodium concentrations are predictive of hypoadrenocorticism in hyponatraemic dogs: a retrospective pilot study’. Journal of Small Animal Practice, doi: 10.1111/jsap.12792 (Early view) 
  • Brisson, B.A. et al. (2018) ‘Risk factors and prognostic indicators for surgical outcome of dogs with esophageal foreign body obstructions’. Journal of the American Veterinary Medical Association, 252(3), pp. 301-308. 

Clinical case report: 

Barrand, K.R. (2018) ‘A case of canine intestinal obstruction due to ingestion of a superabsorbent polymer bead’ Journal of Small Animal Practice, doi: 10.1111/jsap.12812 (Early view)

Others:

Book review:

Hill, C. (2018) ‘Small Animal Emergency and Critical Care’ Veterinary Record 182(1), p. 27.

Pick of the Month

As voted for by members of our private Facebook group.

A retrospective study of feline trauma patients admitted to a referral centre

Hernon, T. et al (2018) Journal of Small Animal Practice, doi: 10.1111/jsap.12815  (Early view)

Trauma patients are a common presentation in both first opinion and referral veterinary practices. 

This study aims to: 

  • Document the initial management of trauma patients in primary care practices
  • Identify prognostic indicators for feline trauma patients 
  • Give recommendation for initial management of feline trauma patients 
  • 185 cats were enrolled in the study. The population consisted of cases seen in primary care practices for injuries due to traumatic events, then referred as emergencies to North-West Veterinary Specialists (Cheshire, UK). 

The authors classified patients according to a previously described  Severity Score (SS) system (Rochlitz, 2004).

Main findings: 

  • RTA was the most common cause of trauma (56%) followed by unknown origin (27%), falls (10%) and dog attacks (3%)
  • According to the referring veterinary surgeons (RVSs) 35% of cats were in circulatory shock, 45% received antibiotics prior to referral, 72% were administered NSAID either alone or in combination with opioids and 4% received corticosteroids
  • SS4 cats were the most frequently referred cases (nearly 50%) followed by SS3 (28%) and SS5 (21%)
  • The length of hospitalisation increased with SS with an overall mean time of 7 days 
  • 33% of the cases developed complications during hospitalisation, the more common of which were: sciatic nerve dysfunction (10%), tissue necrosis (4%) and urinary incontinence (3%)
  • Cats involved in RTAs had a higher rate of complications and mortality compared to other traumatic events
  • 12% of cats did not survive to discharge - 54% were euthanised and 91% were patients presenting with multiple injuries 
  • Mortality rate increased with increasing SS, with SS5 having a 43% rate of death compared to 3% for both SS3 and SS4
  • 21% of cats initially diagnosed with circulatory shock by the RVS died vs 7% of those who were not

Conclusions: 

  • An injury based scoring system might be useful in the initial assessment of cats following a traumatic event and could provide some prognostic indications regarding mortality in these patients
  • The duration of hospitalisation was closely related to SS, this may be useful when discussing expectations and financial commitments with owners
  • Early identification and stabilisation of circulatory shock is a key step to improve survival in trauma patients prior to referral, however clear guidelines regarding resuscitation end-points are still lacking
  • Analgesia was widely used by RVSs, however, the administration of NSAID in potentially haemodynamically unstable patients was also very frequent, furthermore, some RVSs still used corticosteroids in these cases. 

Limitations:

  • Lack of standardised treatment protocols prior to referral 
  • No unanimous definition of circulatory shock amongst RVSs
  • Variability in amount and thoroughness of clinical data provided by RVSs prior to referral 
  • Potential population bias due to intermediate SS being more likely to be referred than very low or very high SS
  • Definition of mortality was limited to discharge without any follow-up available and included euthanised patients 

Reference:

Rochlitz , I. ( 2004 ) ‘Clinical study of cats injured and killed in road traffic accidents in Cambridgeshire'. Journal of Small Animal Practice 45(8), 390 - 394.

For a copy of any of the papers mentioned in this post (personal education purposes only), including details of the scoring system, please email lara.brunori@gmail.com.