Surgical interventions and outcome in a population of feline trauma patients.

OBJECTIVE: To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population. DESIGN: Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases. SETTING: University teaching hospital. ANIMALS: Two hundred and fifty-one cats presenting for traumatic injury between May 2017 and July 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P < 0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P < 0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P = 0.0553). No difference in modified Glasgow Coma Scale score was found between any groups. CONCLUSIONS: Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.

Animal Trauma Triage Score, Modified Glasgow Coma Scale, age, and weight were associated with outcome in feline bite wounds (1,065 cases): a VetCOT registry study.

OBJECTIVE: To identify associations between admission variables, Animal Trauma Triage (ATT) score, and Modified Glasgow Coma Scale (MGCS) score with need for transfusion or surgical interventions and survival to discharge in cats with bite wounds. ANIMALS: 1,065 cats with bite wounds. PROCEDURES: Records of cats with bite wounds were obtained from the VetCOT registry from April 2017 to June 2021. Variables included point of care laboratory values, signalment, weight, illness severity scores, and surgical intervention. Associations between admission parameters, terciles of MGCS, quantiles of ATT scores, and death or euthanasia were assessed using univariable and multivariable logistic regression analysis. RESULTS: 872 cats (82%) survived to discharge, while 170 (88%) were euthanized and 23(12%) died. In the multivariable model, age, weight, surgical treatment, ATT and MGCS scores were associated with nonsurvival. For every 1 year of age, odds of nonsurvival increased by 7% (P = .003) and for every 1 kg of body weight, odds of nonsurvival decreased by 14% (P = .005). Odds of dying increased with lower MGCS and higher ATT scores (MGCS: 104% [95% CI, 116% to 267%; P < .001]; ATT: 351% [95% CI, 321% to 632%; P < .001). Odds of dying decreased by 84% (P < .001) in cats that underwent surgery versus those that did not. CLINICAL RELEVANCE: This multicenter study indicated association of higher ATT and lower MGCS with worse outcome. Older age increased the odds of nonsurvival, while each kilogram increase in bodyweight decreased odds of nonsurvival. To our knowledge, this study is the first to describe associations of age and weight with outcome in feline trauma patients.

Prospective evaluation of the Animal Trauma Triage Score and Modified Glasgow Coma Scale in 25 cats with high-rise syndrome.

OBJECTIVES: The purpose of this study was to prospectively evaluate the prognostic utility of the Animal Trauma Triage Score (ATTS) and Modified Glasgow Coma Scale (MGCS) in cats with high-rise syndrome. METHODS: ATTS and MGCS were obtained upon arrival from 25 client-owned cats presented for high-rise syndrome. Cases were followed during hospitalisation and several variables, including outcome, were recorded. RESULTS: The mortality rate in this cohort of cats with high-rise syndrome was 16%. Univariate statistical analysis showed that lactate (P = 0.022), creatinine (P = 0.01), body weight (P = 0.036) and ATTS (P = 0.02) were higher and MGCS (P = 0.011) lower among non-survivors. Multivariable statistical analysis showed that ATTS was the only factor significantly associated with mortality (odds ratio 2.41, 95% confidence interval [CI] 1.02-5.71; P = 0.046). A receiver operating characteristics curve showed that ATTS was an excellent predictor of mortality (area under the curve 0.917, 95% CI 0.8-1.0; P = 0.009). An ATTS cut-off of 6.0 had a 75% sensitivity and 90% specificity for non-survival and a cut-off of 10 had a 25% sensitivity and 100% specificity for non-survival. CONCLUSIONS AND RELEVANCE: ATTS is predictive of severity and outcome in cats with high-rise syndrome and can help facilitate decision-making by owners and veterinarians.

A multicenter retrospective comparison of trauma in toy breeds versus giant breeds: A Veterinary Committee on Trauma registry study.

OBJECTIVE: To retrospectively evaluate and stratify the differences in signalment, mechanisms, and severity of injury between toy and giant breed dogs. DESIGN: Retrospective, observational cohort study. SETTING: Multicenter, university veterinary teaching hospital, and private referral hospitals contributing to Veterinary Committee on Trauma (VetCOT) patient registry. ANIMALS: Two thousand seven hundred and five (2589 toy and 116 giant breed) dogs presented for trauma with complete data entries recruited into the Veterinary Committee on Trauma registry from September 1, 2013 through December 31, 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Injury etiology in toy breeds was predominantly blunt trauma (1532/2587 [59.2%]), commonly falling from a height or motor vehicle accident, whereas in giant breeds penetrating trauma was more common (71/116 [61.2%]). Eighty-seven percent (2231/2558) of toy breeds and 94.7% (108/114) giant breeds survived to discharge. When stratified by severity of injury (animal trauma triage [ATT] ≥ 5), mortality increased. Severely injured toy breeds had a 45.6% (200/438) survival rate, and severely injured giant breeds had a 62.5% (5/8) survival rate. Patient size did not impact survival in a logistic regression model; however, ATT score (odd ratio, 0.55; 95% CI, 0.52-0.58; P < 0.001), modified Glasgow Coma Scale (mGCS; odds ratio, 1.2; 95% CI, 1.11-1.32; P < 0.001), and base excess (odds ratio, 1.15; 95% CI, 1.09-1.22; P < 0.001) were predictive of nonsurvival. Surgical intervention was required in 743 of 2587 (29%) toy breeds and 65 of 116 (56%) giant breeds. Surgery was associated with an increased survival rate (odds ratio, 4.43; 95% CI, 2.45-8.83; P < 0.0001). CONCLUSIONS: Evaluation of a large, multicenter dataset showed that ATT score along with base excess, plasma lactate, and mGCS were predictors of mortality independent of patient size. Severely injured dogs, as defined by an ATT score ≥ 5, were less likely to survive, and toy breed dogs had a higher mortality rate than giant breeds in the subcategory.

CT findings and the prognostic value of the Koret CT score in cats with traumatic brain injury.

OBJECTIVES: The aims of this study were to evaluate associations between abnormal head CT findings and outcome, and to examine the prognostic value of the Koret CT score (KCTS) in cats sustaining acute traumatic brain injury (TBI). METHODS: The medical records of cats hospitalised with TBI that underwent head CT scans within 72 h of admission were retrospectively reviewed. CT scans were evaluated independently by a radiologist and a neurologist who were blinded to the outcome. A KCTS and modified Glasgow Coma Scale (MGCS) were assigned to each cat and the association between abnormal CT findings, KCTS, MGCS and outcome were analysed. RESULTS: Fourteen cats were included in the study: nine (64.2%) survivors and five (35.7%) non-survivors. Of the nine cats that were discharged, one was a short-term survivor (10 days) and eight (57.1%) were long-term survivors (⩾6 months). Abnormal CT findings included lateral ventricle asymmetry/midline shift (42.8%), intracranial haemorrhage (35.7%), caudotentorial lesions (14.2%) and cranial vault fractures (14.2%), all of which were depressed. Intracranial haemorrhage was found to be significantly and negatively associated with short-term (P = 0.005) and long-term (P = 0.023) survival. KCTS was significantly associated with short-term survival (P = 0.002) and long-term survival (P = 0.004). A KCTS cut-off value of 2 yielded a 100% sensitivity and 100% specificity for short-term survival and 100% sensitivity and 80% specificity for long-term survival. A MGCS cut-off value of ⩾13 was associated with a 100% sensitivity and 100% specificity for short-term survival, and with a 100% sensitivity and 80% specificity for long-term survival. CONCLUSIONS AND RELEVANCE: KCTS, performed up to 72 h from injury, can be used as an additional diagnostic tool for the prediction of survival in cats with TBI.

ACVECC-Veterinary Committee on Trauma Registry Report 2013-2017.

OBJECTIVE: To report summative data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) registry. DESIGN: Multi-institutional veterinary trauma registry data report. SETTING: VetCOT identified veterinary trauma centers (VTCs). ANIMALS: Dogs and cats with evidence of trauma presented to VTCs with data entered in the VetCOT registry September 1, 2013-March 31, 2017. INTERVENTIONS: VetCOT created a standardized data collection methodology for dog and cat trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in data software use and operational definitions of data variables. Data on demographics, trauma type (blunt vs penetrating), preadmission care, hospitalization and intensive care requirement, trauma severity assessment at presentation (eg, modified Glasgow coma scale and animal trauma triage score), key laboratory parameters, necessity for surgical intervention, and case outcome were collected. Summary descriptive data for each species are reported. MEASUREMENTS AND MAIN RESULTS: Twenty-nine VTCs in North America, Europe, and Australia contributed information from 17,335 dog and 3,425 cat trauma cases during the 42-month reporting period. A large majority of cases presented directly to the VTC after injury (80.4% dogs and 78.1% cats). Blunt trauma was the most common source for injury in cats (56.7%); penetrating trauma was the most common source for injury in dogs (52.3%). Note that 43.8% of dogs and 36.2% of cats were reported to have surgery performed. The proportion surviving to discharge was 92.0% (dogs) and 82.5% (cats). CONCLUSIONS: The VetCOT registry proved to be a powerful resource for collection of a large dataset on trauma in dogs and cats seen at VTCs. While overall survival to discharge was quite high, further evaluation of data on subsets of injury types, patient assessment parameters, interventions, and associated outcome are warranted.

Escala de coma de Glasgow pediátrica modificada para cães / Pediatric Glasgow coma scale modified for dogs

Com o objetivo de modificar a escala de coma de Glasgow pediátrica para utilização na medicina veterinária, foram utilizados 30 cães adultos com alterações neurológicas passíveis de avaliação da consciência. A escala modificada para cães foi aplicada em três momentos com intervalos de 48 horas entre eles, resultando em 90 eventos diversos. A escala foi aplicada para avaliação da abertura ocular (AO), da melhor resposta associada à vocalização (MRV) e da melhor resposta motora (MRM). Com a análise fatorial para os indicadores AO, MRV e MRM, obtiveram-se valores iniciais de 2,482, 0,302 e 0,215, respectivamente. A variância foi de 82,7 por cento, 10,1 por cento e 7,2 por cento, respectivamente, e cumulativa de 82,7 por cento, 92,8 por cento e 100 por cento, respectivamente. A extração esperada do principal fator, AO, foi de 2,482 com variância de 82,7 por cento e cumulativa de 82,7 por cento. O resultado da avaliação da consciência dos cães foi normal em 10 por cento dos animais, alteração leve em 20 por cento, moderada em 45 por cento e grave em 25 por cento, com escores de Glasgow iguais a 15, entre 13 e 14, entre 9 e 12 e entre 8 e 3, respectivamente. A escala de coma de Glasgow pediátrica modificada para cães é ferramenta segura para avaliação da consciência de cães adultos.

The pediatric Glasgow coma scale was modified for use in veterinary medicine. Thirty adult dogs with neurological alterations susceptible to evaluation of the conscience were studied. The modified scale for dogs was applied at three moments with intervals of 48 hours, resulting in 90 events. The scale was applied for evaluation of the ocular opening (OO), the best answer associated to vocalization (BAV), and the best motor answer (BMA). With the factorial analysis for the indicators OO, BAV, and BMA the initial values of 2.482, 0.302, and 0.215, respectively, were obtained. The variance was of 82.7 percent, 10.1 percent, and 7.2 percent, respectively, and cumulative of 82.7 percent, 92.8 percent, and 100 percent, respectively. The expected extraction of the main factor, OO, was 2.482 with variance of 82.7 percent and cumulative of 82.7 percent. The evaluation result of the conscience was normal in 10 percent of the animals, light alteration in 20 percent, moderate in 45 percent, and severe in 25 percent, with scores of Glasgow equal to 15, from 13 to 14, nine to 12, and eight to three, respectively. The pediatric Glasgow coma scale modified for dogs was a safe tool for evaluation of the conscience of adult dogs.