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Multicenter prospective evaluation of dogs with trauma

Hall, K.E., Holowaychuk, M.K., Sharp, C.R.ORCID: 0000-0002-1797-9783 and Reineke, E. (2014) Multicenter prospective evaluation of dogs with trauma. Journal of the American Veterinary Medical Association, 244 (3). pp. 300-308.

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Objective — To determine hospital admission variables for dogs with trauma including values determined with scoring systems (animal trauma triage [ATT], modified Glasgow coma scale [MGCS], and acute patient physiologic and laboratory evaluation [APPLE] scores) and the usefulness of such variables for the prediction of outcome (death vs survival to hospital discharge).

Design — Prospective, multicenter, cohort study.

Animals — 315 client-owned dogs.

Procedures — By use of a Web-based data capture system, trained personnel prospectively recorded admission ATT, MGCS, and APPLE scores; clinical and laboratory data; and outcome (death vs survival to discharge) for dogs with trauma at 4 veterinary teaching hospitals during an 8-week period.

Results — Cause of injury was most commonly blunt trauma (173/315 [54.9%]) followed by penetrating trauma (107/315 [34.0%]), or was unknown (35/315 [11.1%]). Of the 315 dogs, 285 (90.5%) survived to hospital discharge. When 16 dogs euthanized because of cost were excluded, dogs with blunt trauma were more likely to survive, compared with dogs with penetrating trauma (OR, 8.5). The ATT (OR, 2.0) and MGCS (OR, 0.47) scores and blood lactate concentration (OR, 1.5) at the time of hospital admission were predictive of outcome. Surgical procedures were performed for 157 (49.8%) dogs; surgery was associated with survival to discharge (OR, 7.1).

Conclusions and Clinical Relevance — Results indicated ATT and MGCS scores were useful for prediction of outcome for dogs evaluated because of trauma. Penetrating trauma, low blood lactate concentration, and performance of surgical procedures were predictive of survival to hospital discharge. The methods enabled collection of data for a large number of dogs in a short time.

Trauma, defined as tissue injury caused by violence or accident that occurs suddenly and includes physical damage to the body,1 is a common cause of morbidity and death in dogs. Results of large-scale epidemiological studies2,3 indicate that trauma accounts for approximately 11% to 13% of all animals evaluated at urban veterinary teaching hospitals. In a recent study4 in which causes of death in > 74,000 dogs were evaluated, trauma was the second most common cause of death in juvenile dogs (following infectious disease) and adult dogs (following neoplasia). Results of multiple large retrospective studies2,5–8 indicate the injury characteristics and clinical and laboratory variables for dogs with trauma, including patient demographics, mechanisms of trauma, frequency of polytrauma, development of multiple organ failure, and prognostic indicators. Predictors of death or euthanasia (ie, nonsurvival) in dogs with trauma determined retrospectively include cardiac arrhythmias, body wall hernias, severe soft tissue injuries, head trauma, vertebral fractures, and recumbency at the time of hospital admission.5,6

Scoring systems, useful for both clinical and research applications, have been investigated for evaluation of dogs following trauma. In clinical practice, scoring systems can be incorporated in protocols developed to improve triage, guide treatments and diagnostic testing, or benchmark patient progress.9 In clinical research, scoring systems can be used to measure effectiveness of randomization and facilitate patient stratification to decrease bias and confounding variables.9 The ATT score was validated by use of a small population of dogs and cats, and its association with outcome (survival to hospital discharge vs nonsurvival) has been subsequently determined in multiple retrospective studies.5,6,10,11 In a retrospective study12 of dogs with head trauma, MGCS scores were predictive for nonsurvival within 48 hours after injury. Most recently, the APPLE scoring system was validated as a user-friendly scoring system for evaluation of dogs admitted to an intensive care unit.3

In other veterinary studies, numerous variables and scoring systems have been investigated for evaluation of dogs hospitalized after trauma; however, such studies have had a retrospective design or included dogs evaluated at a single site. The objective of the study reported here was to prospectively evaluate variables at the time of hospital admission for dogs with trauma, with particular emphasis on scoring systems (ATT, MGCS, and APPLE scores) and the usefulness of such variables for prediction of outcomes. Another objective was to determine the potential usefulness of these methods for evaluation of dogs with trauma in future multicenter prospective clinical trials.

Item Type: Journal Article
Publisher: American Veterinary Medical Association
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