Monthly Journal Round-Up - March 2018

Thanks as always to Lara Brunori DVM CertAVP MRCVS

Clinical practice review:

  • Rosenstein, P.G. et al. (2018) ‘Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement’. Journal of Veterinary Emergency and Critical Care, 28 (2), pp. 85-105
  • Rosenstein, P.G. et al. (2018) ‘Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia’. Journal of Veterinary Emergency and Critical Care, 28 (2), pp. 106-121

Clinical studies:

Prospective:

  • Simon, B.T. et al. (2018) ‘Perceptions and opinions of pet owners in the United States about surgery, pain management, and anaesthesia in dogs and cats’. Veterinary Surgery, 47(2), pp.227-284

Prospective/retrospective: 

  • Mavromatis, M.V. et al. (2018) ‘Utility of two-view vs three-view abdominal radiography in canines presenting with acute abdominal signs’. Veterinary Radiology & Ultrasound, early view - see Pick of the Month below.

Retrospective:

  • Pedro, B. et al. (2018) ’Retrospective evaluation of the effect of heart rate on survival in dogs with atrial fibrillation’. Journal of Veterinary Internal Medicine, 32(1), pp. 86-92
  • Boudreau, C.E. et al. (2018) ‘Reliability of interpretation of neurologic examination findings for the localization of vestibular dysfunction in dogs’. Journal of the American Veterinary Medical Association, 252(7), pp. 830-838
  • Hardy, J.P. et al. (2018) ‘Retrospective evaluation of plasma cholesterol concentration in septic dogs and its association with morbidity and mortality: 51 cases (2005-2015)’. Journal of Veterinary Emergency and Critical Care, 28(2), pp. 149-156. 

Brief clinical communication: 

  • Burton, A.G. et al. (2018) ‘In vitro assessment of the effect of acidemia on coagulation in dogs’. Journal of Veterinary Emergency and Critical Care, 28(2), pp. 168-172.

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

Pick of the Month

Utility of two-view vs. three-view abdominal radiography in canines presenting with acute abdominal signs

Mavromatis, M.V. et al. Veterinary Radiology & Ultrasound (2018) doi: 10.1111/vru.12611

Abdominal radiography is a useful tool for the diagnosis of patients presenting with acute abdominal signs. Standard survey abdominal radiographs include a ventrodorsal and either a left or right lateral view.  However, an increasing number of clinicians have recently transitioned to a three-view study protocol with both lateral projections. 

Due to the effect of gravity on the gas and fluid within the gastrointestinal tract, the appearance of abdominal organs can change significantly between the two lateral recumbencies. 

This study aims at evaluating if a three-view radiographic study of the canine abdomen would: 

  • increase the diagnostic accuracy for gastrointestinal mechanical obstruction, abdominal masses and pancreatitis
  • increase the confidence in the assessor’s recommendation for or against surgical intervention
  • increase General Practitioners’ diagnostic confidence in comparison to Board-certified Radiologists 

Initially, 16 patients were prospectively recruited. Inclusion criteria comprised: signs of acute or acutely worsened gastrointestinal disease like vomiting, inappetence, diarrhoea, constipation and abdominal pain. 

In order to increase the power of the study and reach statistical significance, 32 additional cases were retrospectively enrolled. 

All dogs had three radiographic projections obtained together with complete clinical records including a 2-week follow-up or a post-mortem. 

A total of 48 cases were randomly assigned a number between 1 and 48 and subsequently assigned to two groups of 24 patients each:

  • Group A consisted of two-view radiographic studies (ventrodorsal and right lateral) of cases 1 - 24 and three-view studies of cases 25-48;
  • Group B consisted of the opposite configuration of two- and three-view examinations. 

Two Radiologists and two General Practitioners were assigned to assess each group. 

Reviewers were asked to determine if 10 predetermined findings were present within the set of images. These 10 findings included: normal abdomen, focal small intestinal dilation, diffuse small intestinal dilation, small intestinal plication, gastrointestinal wall thickening, gastric dilation, hepatomegaly, loss of abdominal serosal detail, opaque gastrointestinal foreign body and mass effect.

Answers were submitted with a degree of certainty from 1 (I am certain this finding is not present) to 5 (I am certain this finding is present). 

Study results:

Three-view studies did not yield statistically significant improved diagnostic accuracy versus two-view studies for either General Practitioners or Diplomates;
Overall Diplomates matched the final diagnosis more frequently than General Practitioners especially for: diffuse small intestinal dilation, focal small intestinal dilation, opaque gastrointestinal foreign material and small intestinal plication;
A third view also did not increase General Practitioners’ diagnostic confidence and in the case of evaluating the presence of small intestinal dilation, a third view actually increased uncertainty.

Study limitations: 

  • Four cases were excluded from analysis due to lack of definitive radiographic findings. This significantly reduced the statistical power initially expected;
  • Each reviewer saw every case only once as a two- or three- view examination. Crossover data might have enhanced the reviewers’ confidence level;
  • Reviewers were not given any clinical information on any of the cases and this does not reflect reality in most clinical settings;
  • Since radiographic exams were not required prior to performing abdominal ultrasonography, the study caseload might have been biased towards cases with foreign bodies as compared to cases that reached a clinical or ultrasonographic diagnosis and did not have radiographs requested at all.

Conclusions: 

Evaluation of three-view radiographic examinations, as compared to two-view examinations, of the abdomen did not increase diagnostic accuracy or confidence in correctly identifying key abdominal abnormalities within the images or determining whether surgical intervention was needed. This was true for both Boarded Radiologists and General Practitioners.

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

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