Retrospective analysis of the use of canine-specific albumin in 125 critically ill dogs.

OBJECTIVE: To describe the clinical use of canine-specific albumin (CSA) in critically ill dogs, report adverse events, and evaluate measurable clinical effects of CSA administration. DESIGN: Retrospective case series from 2019 to 2020. SETTING: Large, urban, private-practice referral and emergency center. ANIMALS: Consecutive sample of 125 client-owned dogs administered CSA transfusions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The conditions most commonly associated with the use of CSA were surgical (32/125) and nonsurgical (20/125) gastrointestinal disease. Both serum albumin and total plasma protein concentrations were significantly increased posttransfusion (P < 0.001), and 16% albumin transfusions produced the greatest magnitude increase in serum albumin (P = 0.0015). Concurrent crystalloid administration did not affect change in albumin. While there was no significant improvement in blood pressure seen in those patients that received albumin, a significant improvement in shock index was identified (P = 0.02). Adverse events were uncommon; however, 8 critically ill dogs died during CSA administration. CONCLUSIONS: CSA appears to be a relatively safe alternative to synthetic colloids and complementary to crystalloids in critically ill patients. More concentrated solutions may be more effective in raising serum albumin concentration. Further investigation into the indications for and efficacy of CSA will continue to improve our knowledge of this blood product.

Comparing diagnostic findings and cost of whole body computed tomography to traditional diagnostic imaging in polytrauma patients.

OBJECTIVE: To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT. DESIGN: Prospective, observational study. SETTING: Private, level 1 veterinary trauma center. ANIMALS: Convenience sample of 21 client-owned cats and dogs presenting with polytrauma. INTERVENTIONS: Abdominal and thoracic FAST were performed by the primary clinician, if indicated. Radiographs were performed on areas concerning for trauma at the primary clinician's discretion. A WBCT was performed on each patient within 24 h of presentation and was blindly interpreted by a board-certified radiologist. Patients were only placed under anesthesia if further procedures were planned. IV contrast administration was employed at the discretion of the primary clinician and radiologist. MEASUREMENTS AND MAIN RESULTS: Twenty-one patients (14 dogs and 7 cats) were enrolled. Sources of trauma included blunt force (80%), penetrating wounds (10%), and unknown sources (10%). Twelve injuries were missed on traditional diagnostics tests. Injuries missed on traditional diagnostic workup included pneumothorax, pneumomediastinum, pulmonary contusions, pleural effusion, traumatic bulla, peritoneal effusion, and an appendicular skeleton fracture. A distal metacarpal fracture was missed on WBCT. Traditional diagnostic tests misdiagnosed a diaphragmatic hernia and a ruptured urinary bladder, whereas WBCT was able to rule out these injuries. There were no adverse outcomes associated with missed injuries. The median cost of traditional diagnostic tests was significantly less than the cost of WBCT (P < 0.001). CONCLUSIONS: Although cost is higher, WBCT is a single test that can provide more comprehensive information and may help decrease the risk of missed injuries compared to traditional diagnostic tests. WBCT may be considered as a first-line diagnostic in severely traumatized patients.

Comparison of artificial intelligence to the veterinary radiologist's diagnosis of canine cardiogenic pulmonary edema.

Application of artificial intelligence (AI) to improve clinical diagnosis is a burgeoning field in human and veterinary medicine. The objective of this prospective, diagnostic accuracy study was to determine the accuracy, sensitivity, and specificity of an AI-based software for diagnosing canine cardiogenic pulmonary edema from thoracic radiographs, using an American College of Veterinary Radiology-certified veterinary radiologist's interpretation as the reference standard. Five hundred consecutive canine thoracic radiographs made after-hours by a veterinary Emergency Department were retrieved. A total of 481 of 500 cases were technically analyzable. Based on the radiologist's assessment, 46 (10.4%) of these 481 dogs were diagnosed with cardiogenic pulmonary edema (CPE+). Of these cases, the AI software designated 42 of 46 as CPE+ and four of 46 as cardiogenic pulmonary edema negative (CPE-). Accuracy, sensitivity, and specificity of the AI-based software compared to radiologist diagnosis were 92.3%, 91.3%, and 92.4%, respectively (positive predictive value, 56%; negative predictive value, 99%). Findings supported using AI software screening for thoracic radiographs of dogs with suspected cardiogenic pulmonary edema to assist with short-term decision-making when a radiologist is unavailable.

The prognostic value of admission point-of-care testing and modified Glasgow Coma Scale score in dogs and cats with traumatic brain injuries (2007-2010): 212 cases.

OBJECTIVE: To investigate the association between admission point-of-care parameters and survival to discharge in dogs and cats with traumatic brain injury (TBI). DESIGN: Retrospective study 2007-2010. SETTING: A rural university teaching hospital and an urban private practice teaching hospital. ANIMALS: One hundred thirty-one dogs and 81 cats admitted to the emergency service with evidence of head injury based on history from the owner or physical exam. MEASUREMENTS AND MAIN RESULTS: In dogs, nonsurvivors had significantly higher glucose concentrations at admission than survivors (median = 8.49 mmol/L [153 mg/dl] vs 6.83 mmol/L [123 mg/dl], p = 0.039). In cats, there was no significant difference in admission glucose between survivors and nonsurvivors (median = 10.21 mmol/L [184 mg/dl] vs 10.93 mmol/L [197 mg/dl], p = 0.17). Modified Glasgow Coma Scale (MGCS) score was available for 105 of the 131 dogs (80%) and was significantly higher in survivors than in nonsurvivors (median = 16 vs 11, p < 0.0001). MGCS was available for 45 of the 81 cats (56%) and was significantly higher in survivors than in nonsurvivors (median = 17 vs 14, p = 0.0005). The relative prognostic value of the admission point-of-care testing parameters and MGCS were assessed using a stepwise linear regression model, which included admission glucose, pH, base excess, sodium, and MGCS. In dogs, only admission glucose was an independent predictor of survival (odds ratio = 1.027, 95% confidence interval, 1.0042-1.05, p = 0.019). CONCLUSIONS: These results suggest that, as in people with TBI, increased blood glucose concentrations may have prognostic significance in dogs with TBI but not in cats. In addition, MGCS score may be predictive of survival in both dogs and cats with TBI.

The influence of a fast-track service on case flow and client satisfaction in a high-volume veterinary emergency department.

OBJECTIVE: To assess the benefit of a fast-track service in the emergency department of a large, high-volume veterinary hospital. DESIGN: Prospective, observational, clinical study. SETTING: Emergency department of an urban, tertiary referral veterinary hospital. ANIMALS: All animals presented to the emergency department between April 1 and April 30 in 2017 and 2018 were eligible for inclusion. Only patients seen on days in 2017 corresponding to those days of 2018 during which the fast-track service was available were studied. MEASUREMENT AND MAIN RESULTS: Triage case logs were collected and reviewed for April 2017 (prefast-track) and 2018 (fast-track). The fast-track service was launched as a pilot program in April 2018 to provide expedited care to low acuity patients presented to the emergency department. The median number of daily emergency department cases did not differ between 2017 (45, range 26-64) and 2018 (47, range 38-64; P = 0.3). The median time from presentation until first discussion with a doctor for low acuity cases was lower in April 2017 (29 min, range 1-163) than in April 2018 (24 min, range 1-100; P < 0.001). This reduction in wait time was observed despite a 40% increase in low acuity case presentations in 2018. Wait times for high acuity patients did not differ between study periods. The number of cases that left without being seen was higher in April 2017 compared to April 2018 (77 and 45 cases, respectively P < 0.001). CONCLUSIONS: Implementation of a fast-track service reduced wait time for low acuity cases without adversely impacting wait times for sicker patients and led to a reduction in clients leaving without being seen. By introducing the fast-track service in a large volume veterinary hospital, limited resources can be distributed to improve speed of care, case flow, and client satisfaction in the emergency department.

A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients.

PURPOSE: To evaluate whole blood chloride concentration and hospital-acquired AKI in hospitalized canine patients. Secondary outcome measures included the volume-adjusted chloride load, in-hospital mortality and length of ICU stay. PATIENTS AND METHODS: This is a prospective, observational study. Sixty dogs admitted to the ICU and receiving IV fluid therapy for >24 hours from February 2018 to July 2019. Corrected chloride and creatinine concentrations were obtained twice daily. Total volume of IV fluid and total chloride load were recorded. Volume-adjusted chloride load (VACL) was calculated by dividing the chloride administered by the volume of fluid administered. Hospital-acquired AKI was defined as an increase in creatinine of ≥26.5 µmol/L (0.3 mg/dL) or 150% from baseline to maximum. Survival to hospital discharge or non-survival and ICU length of stay were also recorded. RESULTS: Fifteen out of 60 patients developed hospital-acquired AKI. Maximum corrected chloride was significantly different in AKI group (median 122.3 mmol/L) vs non-AKI group (median 118.1 mmol/L; p=0.0002). Six out of 60 patients developed hyperchloremia. Hyperchloremic patients were significantly more likely to develop in-hospital AKI (p=0.03). Patients hospitalized ≥2 days had a significantly higher [Cl-]max compared to those with shorter ICU stay (121.8 ± 5.9 mmol/L vs 117.5 ± 4.3 mmol/L; p=0.002). Eight out of 60 patients were non-survivors. Maximum corrected chloride and creatinine concentrations were not significantly different between survivors and non-survivors. VACL was not significantly different between AKI or mortality groups. CONCLUSION: Maximum corrected chloride concentration was significantly higher in dogs with hospital-acquired AKI, even amongst dogs without hyperchloremia. Additionally, maximum corrected chloride concentrations were significantly higher in dogs hospitalized in the ICU longer compared to those hospitalized for fewer than two days. There was no significant difference in VACL in any of the outcome groups. Results from this study suggest alterations in chloride may be observed alongside the development of acute kidney injuries. Future studies in critically ill dogs are warranted.

Influence of cross-match on posttransfusion packed cell volume in feline packed red blood cell transfusion.

OBJECTIVE: To evaluate the influence of major cross-match on transfusion efficacy based on the change in PCV following packed red blood cell (pRBC) administration in cats. DESIGN: Retrospective study from January 2000 to December 2010. SETTING: University Teaching Hospital. ANIMALS: Two hundred nine cats received 233 type-specific pRBC transfusions as treatment for anemia. Forty-three transfusions were cross-match compatible and 190 were not screened with cross-match. INTERVENTIONS: Pretransfusion major cross-match. MEASUREMENTS AND MAIN RESULTS: Signalment, body weight, dosage of pRBC transfusion, pretransfusion PCV, posttransfusion PCV, IV fluid volumes administered between the measurement of the pretransfusion PCV and posttransfusion PCV, time delay between pretransfusion PCV measurement and transfusion administration, time between administration of transfusion and posttransfusion PCV measurement, and major cross-match testing data were extracted from the medical records of cats receiving pRBC transfusions and were evaluated for their influence on posttransfusion PCV scaled to dose of pRBC administered. The mean pretransfusion PCV was significantly lower for cross-match compatible transfusions (13.7 ± 4.2%) compared to noncross-matched transfusions (16.1 ± 4.5%; independent samples t-test, P < 0.0001). The PCV increase posttransfusion scaled by dose was significantly greater for cross-match compatible transfusions (1.02 ± 0.51%/mL/kg) than for noncross-matched transfusions (0.74 ± 0.65%/mL/kg; independent samples t-test, P = 0.0093). Of age, dose of pRBCs, cross-match status, reason for transfusion, pretransfusion PCV, and dose of IV fluids administered between the pretransfusion and posttransfusion PCV, only pRBC dose, cross-match status, and pretransfusion PCV were independent predictors of change in PCV with transfusion on multiple regression analysis (coefficient = 0.507, P < 0.0001; coefficient = 1.64, P = 0.041; coefficient = -0.235, P = 0.0009, respectively). CONCLUSIONS: In this retrospective study, administration of type-specific, cross-match compatible pRBC transfusions resulted in significantly greater increases in the posttransfusion PCV when compared to administration of typed, noncross-matched pRBCs. Future prospective studies evaluating the effect of cross-match on transfusion efficacy in cats are warranted.