Physical examination and CT to assess thoracic injury in 137 cats presented to UK referral hospitals after trauma.

OBJECTIVES: The aim of the study was to describe clinical examination and thoracic CT (TCT) findings in cats after trauma, and to identify physical examination findings associated with both abnormalities on TCT and the need for therapeutic interventions. METHODS: A multicentre, retrospective, observational study was conducted. Cats admitted to the participating hospitals with a history of blunt trauma and that underwent TCT were eligible. Data were collected on signalment, history, physical examination, TCT findings and subsequent interventions. RESULTS: In total, 137 cats were included. Road traffic accidents (RTAs) were the most frequently reported cause of trauma (69%). Tachypnoea (32%), pale mucous membranes (22%) and dyspnoea (20%) were the most common abnormal findings on thoracic examination. The most frequently identified thoracic pathologies on TCT were atelectasis (34%), pulmonary contusions (33%), pneumothorax (29%) and pleural effusion (20%). Thoracocentesis was the most commonly performed intervention (12%), followed by chest drain placement (7%). A total of 45 (33%) cats had no physical examination abnormalities but did have abnormalities detected on TCT; six of these cats required interventions. Increasing numbers of thoracic abnormalities on clinical examination were associated with increasing likelihood of having abnormal findings on TCT (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.21-3.44, P = 0.008) and of requiring an intervention (OR 1.82, 95% CI 1.32-2.51, P <0.001). CONCLUSIONS AND RELEVANCE: RTAs were the most common reported cause of blunt trauma. Atelectasis, pulmonary contusions and pneumothorax were the most common abnormalities identified on TCT, and thoracic drainage was the most utilised intervention. TCT may be useful in identifying cats with normal thoracic physical examination findings that have significant thoracic pathology, and a high number of abnormal findings on thoracic examination should raise suspicion for both minor and major thoracic pathology. The results of this study can be used to assist in selecting appropriate cases for TCT after blunt trauma.

ACVECC-Veterinary Committee on Trauma registry report 2017-2019.

OBJECTIVE: To report summative data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) registry. DESIGN: Multi-institutional registry data report, April 1, 2017 to December 31, 2019. SETTING: VetCOT identified and verified Veterinary Trauma Centers (VTCs). ANIMALS: Dogs and cats with evidence of trauma. INTERVENTIONS: Data were input to a web-based data capture system (Research Electronic Data Capture) by data entry personnel trained in data software use and operational definitions of data variables. Data on demographics, trauma type, preadmission care, trauma severity assessment at presentation (modified Glasgow Coma Scale and Animal Trauma Triage score), key laboratory parameters, interventions, and case outcome were collected. Summary descriptive data for each species are reported. MEASUREMENTS AND MAIN RESULTS: Thirty-one VTCs contributed data from 20,842 canine and 4003 feline trauma cases during the 33-month reporting period. Most cases presented directly to a VTC (82.1% dogs, 82.1% cats). Admission to hospital rates were slightly lower in dogs (27.8%) than cats (32.7%). Highest mortality rates by mechanism of injury in dogs were struck by vehicle (18.3%), ballistic injury (17.6%), injured inside vehicle (13.2%), nonpenetrating bite wound (10.2%), and choking/pulling injury (8.5%). Highest mortality rates by mechanism of injury in cats were struck by vehicle (43.3%), ejected from vehicle (33.3%), nonpenetrating bite wound (30.7%), ballistic injury (27.8%), and choking/pulling injury (25.0%). The proportion of animals surviving to discharge was 93.1% (dogs) and 82.5% (cats). CONCLUSIONS: The VetCOT registry is a powerful resource for collection of a large dataset on trauma in dogs and cats seen at VTCs. Overall survival to discharge was high indicating low injury severity for most recorded cases. Further evaluation of data on subsets of injury types, patient assessment parameters, interventions, and associated outcome are warranted. Data from the registry can be leveraged to inform clinical trial design and justification for naturally occurring trauma as a translational model to improve veterinary and human trauma patient outcome.

Evaluation of outcome associated with feline trauma: A Veterinary Committee on Trauma registry study.

OBJECTIVE: To evaluate outcome (survival to discharge) among trauma types (blunt, penetrating, both) in cats. Secondary objectives were to evaluate for associations between trauma type, injury severity, and the diagnostics and interventions selected by primary clinicians. DESIGN: Retrospective evaluation of veterinary trauma registry data. SETTING: Veterinary Committee on Trauma (VetCOT) veterinary trauma centers (VTCs). ANIMALS: A total of 3895 feline trauma patients entered in the VetCOT trauma registry from April 1, 2017 to December 31, 2019. INTERVENTIONS: Data collected included patient demographics, trauma type, Abdominal Fluid Score (AFS), Animal Trauma Triage (ATT) score, surgical intervention, glide sign on Thoracic Focused Assessment with Sonography for Trauma, Triage, and Tracking (TFAST), pleural effusion on TFAST, modified Glasgow Coma Scale (mGCS), and outcome (survival to discharge). MEASUREMENTS AND MAIN RESULTS: Data from 3895 cats were collected over a 30-month period. Incidence of trauma types was as follows: blunt, 58% (95% confidence interval [CI]: 56%-59%); penetrating, 35% (95% CI: 34%-37%); and combination, 7.4% (95% CI: 6.7%-8.3%). Differences in survival incidence among the trauma types were identified: blunt, 80% (95% CI: 78%-81%); penetrating, 90% (95% CI: 89%-92%); and combined, 68% (95% CI: 63%-74%) (P < 0.01). Cats in the penetrating trauma group had the lowest proportion of severe injuries (6%) and highest proportion of mGCS of 18 (89%); cats with combined trauma had the highest proportion of severe injuries (26%) and lowest proportion of mGCS of 18 (63%). Point-of-care ultrasound and surgery were not performed in the majority of cases. When surgery was performed, the majority of blunt cases' procedures occurred in the operating room (79%), and the majority of penetrating cases' procedures were performed in the emergency room (81%). CONCLUSIONS: Cats suffering from penetrating trauma had the best outcome (survival), lower ATT scores, and higher mGCS overall. Cats that sustained a component of blunt trauma had a lower survival rate, higher ATT scores, and the highest proportion of mGCS <18.

Comparison of clinical outcomes in cases of blunt, penetrating, and combination trauma in dogs: A VetCOT registry study.

OBJECTIVE: To evaluate outcome (survival to discharge) among trauma types (blunt, penetrating, both) in dogs. The secondary objective was to evaluate if other trauma registry parameters differ between trauma types and influence survival. DESIGN: Retrospective evaluation of veterinary trauma registry data. SETTING: Veterinary Committee on Trauma (VetCOT) identified Veterinary Trauma Centers (VTCs). ANIMALS: A total of 20,289 canine trauma patients with data entered in the VetCOT trauma registry from April 1, 2017 to December 31, 2019 INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were obtained from the VetCOT database and included patient demographics, trauma type (blunt, penetrating, both), Animal Trauma Triage (ATT) score, modified Glasgow Coma Scale (mGCS), abdominal fluid score (AFS), loss of glide sign on thoracic focused assessment with sonography for trauma (TFAST), pleural effusion on TFAST, surgical procedure performed and in what location (emergency room vs operating room), and outcome. Data from 20,289 dogs were collected over a 30-month period. The most common type of trauma was penetrating (10,816, 53.3%), followed by blunt (8360, 41.2%) and then combined blunt and penetrating trauma (1113, 5.5%). Dogs suffering only penetrating trauma had a 96.5% survival rate, blunt trauma had an 89.5% survival rate, and combined trauma had an 86.3% survival rate. Dogs suffering from both types of trauma had higher ATT scores, lower mGCS scores, and were more likely to be admitted to the ICU. Trauma type, mGCS, and ATT score were found to be associated with survival. CONCLUSIONS: The present study highlights that dogs suffering from a combination of blunt and penetrating trauma are more likely to suffer moderate to severe injuries, have lower survival rates, and are more likely to be admitted to the ICU compared to dogs suffering from only blunt or penetrating trauma. Trauma type, mGCS, and ATT scores were found to be associated with survival in all groups.

Feline ureteral rupture with para-ureteral urinomas following blunt trauma: clinical presentation and long-term outcome after treatment by urinary diversion for five cases from 2012 to 2019.

CASE HISTORY: Medical records were reviewed for cats that underwent surgical treatment of traumatic ureteral rupture (TUR) using urinary diversion procedures between 2012 and 2019. CLINICAL FINDINGS AND TREATMENT: Five cats had presented with injuries associated with road traffic accidents. These included three cats with abdominal hernias that required surgical management. At a median of 15 days after the accident, cats represented with lethargy, the presence of an abdominal mass or with lower urinary tract symptoms and in all cats contrast diagnostic imaging showed proximal unilateral TUR with associated para-ureteral urinoma. Four cats received subcutaneous ureteral bypass (SUB) device placement and one had ureteral anastomosis over a stent. Unilateral cyst-like retroperitoneal fluid consistent with para-ureteral urinoma was observed in all cats and a diffuse retroperitoneal haematoma was noticed in four cats. No immediate major complications occurred, and all cats had post-operative serum creatinine concentration within the reference interval. The cat that had received a ureteral stent subsequently required placement of a SUB following stent encrustation 15 months after surgery. Median follow-up time was 34 (min 28, max 58) months and renal function was normal in all cats at the last follow-up. CLINICAL RELEVANCE: Urinary diversion procedures provided long-term stable renal function following proximal TUR in these five cats. Delayed, subtle non-specific clinical signs subsequent to high-energy blunt trauma causing abdominal hernia and associated diffuse retroperitoneal haematoma, should raise suspicion of TUR. ABBREVIATIONS: AFAST: Abdominal focused assessment with sonography for trauma; SUB: Subcutaneous ureteral bypass; TUR: Traumatic ureteral rupture.

Markers of tissue perfusion and their relation to mortality in dogs with blunt trauma.

OBJECTIVE: To evaluate admission Animal Trauma Triage (ATT) score, shock index (SI), and markers of perfusion, including base excess (BE), plasma lactate, and lactate clearance in dogs with blunt trauma. DESIGN: Prospective observational clinical study from 2013 to 2015. SETTING: Private veterinary referral and emergency center. ANIMALS: Forty-four client-owned dogs hospitalized following blunt trauma. INTERVENTION: Within 1 hour of presentation and prior to fluid administration an initial hematocrit, total plasma protein, blood glucose, plasma lactate, blood gas, and electrolytes were obtained for analysis. Plasma lactate concentrations were also measured 4 and 8 hours following initial measurement, and a 4-hour lactate clearance was calculated if patients had an increased admission plasma lactate. ATT score and SI were calculated for each patient based on admission data. Outcome was defined as survival to hospital discharge. MEASUREMENTS AND MAIN RESULTS: Twenty-nine dogs survived, 14 were euthanized, and 1 died. Nonsurviving dogs had a lower mean pH (7.28 ± 0.03 vs 7.36 ± 0.01, P = 0.006), lower median HCO3 (15.7 vs 18.8 mmol/L, P = 0.004), lower median admission BE (-11.0 vs -7.0 mmol/L, P = 0.004), and higher median admission lactate (3.1 vs 2.4 mmol/L, P = 0.036) than those who survived. Median ATT was significantly higher in nonsurvivors (5 vsF 2, P < 0.001). The SI was not significantly different between survivors and nonsurvivors (P = 0.41). There was no difference in median 4-hour lactate (P = 0.34), median 8-hour lactate (P = 0.19), or 4-hour lactate clearance (P = 0.83) in survivors compared to nonsurvivors. No other statistically significant differences were noted between groups. CONCLUSION: Dogs hospitalized following blunt trauma with a lower admission pH, HCO3 , and BE and a higher admission plasma lactate were less likely to survive to hospital discharge. Median ATT score was also significantly higher in nonsurvivors. Although lactate clearance was not predictive of survival, the sample size was small, and additional studies with a larger study population are warranted.

Epidemiology of severe trauma in cats: An ACVECC VetCOT registry study.

OBJECTIVES: To identify demographic information, epidemiological factors, and clinical abnormalities that differentiate cats with severe trauma, defined as an Animal Trauma Triage Score (ATTS) ≥3 from those with mild injury (ATTS 0-2). DESIGN: Multicenter observational study utilizing data from the American College of Veterinary Emergency and Critical Care (ACVECC) Veterinary Committee on Trauma (VetCOT) registry. SETTING: ACVECC VetCOT Veterinary Trauma Centers. ANIMALS: A total of 3859 cats with trauma entered into the ACVECC VetCOT registry between April 1, 2017 and December 31, 2019. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Cats were categorized by ATTS 0-2 (mild, 65.1%) and ≥3 (severe, 34.9%). There was no age difference between categories. Male animals, particularly intact animals, were overrepresented. Blunt trauma was more common than penetrating, with blunt trauma and a combination of blunt and penetrating trauma being more common in the severe trauma group. While 96.6% of cats with ATTS 0-2 survived to discharge, only 58.5% with ATTS ≥3 survived. Only 46.8% of cats with severe trauma had a point-of-care ultrasound performed, of which 8.9% had free abdominal fluid noted. Hospitalization and surgical procedures were more common in the severe trauma group. Transfusions occurred more frequently in the severe trauma group but only in 4.1% of these cats. Other than ionized calcium, all recorded clinicopathological data (plasma lactate, base excess, PCV, total plasma protein, blood glucose) differed between groups. CONCLUSION: Feline trauma patients with an ATTS ≥3 commonly present to Veterinary Trauma Centers and have decreased survival to discharge compared to patients with ATTS 0-2. Differences exist between these groups, including an increased frequency of blunt force trauma (particularly vehicular trauma), head and spinal trauma, and certain clinicopathological changes in the ATTS ≥3 population. Relatively low incidences of point-of-care ultrasound evaluation and transfusions merit further investigation.

Porcine spleen as a model organ for blunt injury impact tests: An experimental and histological study.

The spleen is a large and highly vascularized secondary lymphatic organ. Spleen injuries are among the most frequent trauma-related injuries in the abdominal region. The aims of the study were to assess the volume fractions of the main splenic tissue components (red pulp, white pulp, trabeculae and reticular fibres) and to determine the severity of splenic injury due to the experimental impact test. Porcine spleens (n = 17) were compressed by 6.22 kg wooden plate using a drop tower technique from three impact heights (50, 100 and 150 mm corresponding to velocities 0.79, 1.24 and 1.58 m/s). The pressure was measured via catheters placed in the splenic vein. The impact velocity was measured using lasers. The severity of induced injuries was analysed on the macroscopic level. The volume fractions of splenic components were assessed microscopically using stereology. The volume fraction of the red pulp was 76.4%, white pulp 21.3% and trabeculae 2.7% respectively. All impact tests, even with the low impact velocities, led to injuries that occurred mostly in the dorsal extremity of the spleen, and were accompanied by bleeding, capsule rupture and parenchyma crushing. Higher impact height (impact velocity and impact energy) caused more severe injury. Porcine spleen had the same volume fraction of tissue components as human spleen, therefore we concluded that the porcine spleen was a suitable organ model for mechanical experiments. Based on our observations, regions around hilum and the diaphragmatic surface of the dorsal extremity, that contained fissures and notches, were the most prone to injury and required considerable attention during splenic examination after injury. The primary mechanical data are now available for the researchers focused on the splenic trauma modelling.

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.

Survey of current trends in the management of traumatic subcutaneous emphysema in dogs.

BACKGROUND: Subcutaneous emphysema (SCE) is a common occurrence in emergency veterinary practice, but published information regarding treatment and management strategies is lacking. This study examined trends in diagnostic and treatment recommendations. STUDY DESIGN: An internet-based survey with cross-sectional analysis. There were 129 respondents: board-certified and nonboard-certified veterinarians in private practice and university settings. KEY FINDINGS: Significant differences in the choice of diagnostics and treatment were found based on the etiology and severity of SCE and between respondent groups. Computed tomography (CT) was selected more frequently for SCE resulting from blunt or penetrating traumas by the board-certified veterinarians practicing in a teaching hospital (VTH group; P < 0.001). All veterinarians were more likely to select tracheobronchoscopy as part of their workup for SCE as a result of endotracheal intubation trauma (P = 0.0093 [penetrating traumas]; P = 0.0002 [blunt force traumas]). Intermittent SC drainage and ventral cervical exploratory surgery were more likely to be chosen as treatments when SCE was classified as severe generalized (P < 0.0001). SIGNIFICANCE: There is significant variation in the treatment of SCE in veterinary medicine as well as associated diagnostics to determine severity and treatment options. Further studies are indicated to determine the optimal approach and provide guidance to clinicians.

Clinical findings associated with blunt ocular trauma in horses: a retrospective analysis.

OBJECTIVE: Identify ocular findings associated with blunt ocular trauma to aid in differentiation from other equine ocular diseases. STUDY DESIGN: Retrospective case-control study. METHODS: Medical records of horses at the Equine Clinic Munich-Riem, Munich, Germany and Auburn University, College of Veterinary Medicine were reviewed. Age, sex, breed, laterality, and clinical findings on ophthalmic examination, as well as an observed (confirmed) or unobserved (suspected) history of trauma, were recorded. Statistical analysis was performed to identify any correlation between clinical signs and blunt ocular trauma. Fifty-nine clinical signs were evaluated, and their association with blunt ocular trauma and non-traumatic uveitis was determined. The frequency of clinical signs associated with non-traumatic uveitis was also reported. RESULTS: Fifty-five eyes affected with blunt trauma were included. The comparison group consisted of 233 eyes (168 horses) diagnosed with non-traumatic uveitis. The most frequent ocular findings after BOT included cataract (36/55, 65.5%), corneal edema (26/55, 47.2%), decreased intraocular pressure (23/55, 41.8%), aqueous flare (19/55, 34.5%), lens subluxation, luxation, or lens loss (18/55, 32.7%), fibrin in the anterior chamber (18/55, 32.7%), hyphema (16/55, 29.1%), peripapillary depigmentation ("butterfly lesion") (16/55, 29.1%), conjunctival hyperemia (16/55, 29.1%), corneal fibrosis (15/55, 27.3%), corpora nigra avulsion (14/55, 25.5%), blepharospasm (13/55, 23.6%), and iridodialysis (11/55, 20.0%). CONCLUSIONS: The characteristic pattern of ocular signs associated with blunt ocular trauma may assist in differentiation from other types of uveitis and may improve interpretation of ocular lesions identified during pre-purchase examinations. This study also represents the first peer-reviewed documented and photographed cases of iridodialysis in the horse.

DIPLOTRIAENA OBTUSA (NEMATODA: DIPLOTRIAENIDAE) FROM BARN SWALLOWS (HIRUNDO RUSTICA) AND CLIFF SWALLOWS (PETROCHELIDON PYRRHONOTA) COLLECTED DURING MORTALITY EVENTS IN THE UPPER MIDWEST, USA.

Several mortality events involving barn swallows (Hirundo rustica) and cliff swallows (Petrochelidon pyrrhonota) were reported in the Upper Midwestern states in 2017 and 2018. Barn swallow mortality followed unseasonal cold snaps, with the primary cause of death being emaciation with concurrent air sac nematodiasis. Lesions in cliff swallows were consistent with blunt force trauma from suspected car impacts. Examination of air sac nematodes from both bird species revealed morphological characters consistent with Diplotriaena obtusa. Sequence analysis of the partial 18S rRNA gene indicated the samples clustered with other species in the genus Diplotriaena. These nematodes provide a link between morphological specimens and DNA sequence data for D. obtusa.

Comparison of trauma sustained by civilian dogs and deployed military working dogs.

OBJECTIVE: To compare the prevalence of types of trauma, mechanisms of injury, and outcomes among military working dogs (MWDs), operational canines (OpK9s), and civilian dogs (CDs) that sustained traumatic injury. DESIGN: Retrospective descriptive analysis. ANIMALS: One hundred and ninety-three cases of MWD trauma, 26,099 cases of CD trauma, 35 cases of OpK9 trauma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records of MWDs that incurred trauma while deployed to the Middle East were identified, and information was extracted from these records. The resultant database was compared to CD and OpK9s in the American College of Veterinary Emergency and Critical Care (ACVECC) Veterinary Committee on Trauma registry. All 3 groups showed similar trends with regard to type of trauma: penetrating injuries occurred most frequently, followed by blunt injuries for CDs and OpK9s. An equal proportion of blunt and blunt and penetrating traumas were observed in MWDs. Only MWDs sustained trauma from explosions, which accounted for 22.3% of injuries in this group. Animal bite/scratch/quilling and motor vehicle accidents (MVAs) were significantly more prevalent among CDs than MWDs (P < 0.01), whereas injuries from gunshot wounds (GSW) or a knife/sharp object were more common among MWDs compared to CDs (P < 0.01). No statistical differences in survival were observed between CDs and MWDs after excluding civilian dogs euthanized due to financial limitations. CONCLUSIONS: MWDs, OpK9s, and CDs experience differences in injury type, mechanism, and outcome. Regardless, MWDs and CDs have good prognosis for survival to discharge after trauma.

Evaluation of physical euthanasia for neonatal piglets on-farm.

Twenty-seven neonate piglets (range from 0.35 to 1.17 kg) were evaluated for the effectiveness of blunt force trauma as a method of on-farm cull. Brainstem function, brain injury, and hemorrhage scores (increasing from 0 to 3) were assessed after striking the head against a concrete floor. Electroencephalograms (EEG) from a subset of 15 piglets were recorded before and after blunt force trauma for electrophysiological assessments. Blunt force trauma was performed by a single experienced farmer in a commercial farm by holding the piglet by its both hind legs and striking the head against the concrete floor. All piglets remained recumbent and did not show brainstem reflexes. Only one piglet did not presented tonic/clonic physical activity. The mean time to the onset of persistent isoelectric EEG was 64.3 ± 7.3 s (range 18 to 115). Total power, theta, alpha, and beta power decreased to approximately 45%, 30%, 20%, and 15% from pretreatment power, respectively, by 15-s post-impact. There were no periods of normal-like EEG after the culling. Bruises in the neck and shoulder were found in 67% and 70% of piglets, respectively. All piglets presented skull fractures with 20% having the nasal bone(s) fractured. Brain damage was found in all piglets, mainly in the frontal lobe(s). The occipital lobe(s) presented the greatest frequency of severe damage. The analysis of the radiographs also found a high frequency of fractures in this region. Hemorrhage was most frequent in the frontal, parietal, occipital lobes, and midbrain. When performed correctly with the appropriate weight class, blunt force trauma can be used as an effective method for the on-farm killing of nursing piglets resulting in death. However, this method should not be promoted over more reliable and repeatable cull methods such as captive bolt gun. As with blunt force trauma, there is a significant potential for animal welfare harm associated with inappropriate practice, lack of accuracy, issues with repeatability, and operator fatigue.

Association between cardiac troponin I concentrations and electrocardiographic abnormalities in dogs with blunt trauma.

OBJECTIVE: To determine whether a normal cardiac troponin I (cTnI) concentration and normal ECG on entry rule out the development of a clinically significant cardiac arrhythmia (CSCA, defined as an arrhythmia requiring anti-arrhythmic treatment) in dogs that have sustained blunt trauma. DESIGN: Prospective, observational study. Client-owned dogs were enrolled between January 2015 and November 2016. SETTING: University teaching hospital. ANIMALS: Forty-seven client-owned dogs with a history of witnessed or suspected blunt trauma within 24 hours prior to presentation to the hospital. INTERVENTIONS: On admission to the emergency service, dogs had a standard 3-lead ECG and cTnI concentration (using a veterinary point-of-care device* ) performed. Animal Trauma Triage (ATT) scores, Modified Glasgow Coma Scale (MGCS), and the details regarding the nature and timing of the injury were recorded. The patients were monitored in the ICU for a minimum of 24 hours on continuous ECG telemetry. Cardiac rhythm was monitored every hour, and any abnormalities were noted. The need for anti-arrhythmic therapy was recorded. There were no treatment interventions. MEASUREMENTS AND MAIN RESULTS: Five of 47 dogs (10.6%) developed a CSCA during hospitalization after sustaining blunt trauma. A normal entry ECG and normal cardiac troponin concentration on entry had a 100% negative predictive value (NPV) for ruling out the development of a CSCA, although a normal cardiac troponin concentration alone also had an NPV of 100%. A normal entry ECG had an NPV of 95.3%. The prognosis for survival to discharge was 89.4% in this study population (42/47 dogs). CONCLUSIONS: In dogs with blunt trauma, an entry cTnI concentration or a combination of cTnI and ECG on entry may be useful in determining which patients are at a higher risk for the development of CSCA during the first 12 to 24 hours after the trauma.

Detection of posttraumatic pneumothorax using electrical impedance tomography-An observer-blinded study in pigs with blunt chest trauma.

INTRODUCTION: Posttraumatic pneumothorax (PTX) is often overseen in anteroposterior chest X-ray. Chest sonography and Electrical Impedance Tomography (EIT) can both be used at the bedside and may provide complementary information. We evaluated the performance of EIT for diagnosing posttraumatic PTX in a pig model. METHODS: This study used images from an existing database of images acquired from 17 mechanically ventilated pigs, which had sustained standardized blunt chest trauma and had undergone repeated thoracic CT and EIT. 100 corresponding EIT/CT datasets were randomly chosen from the database and anonymized. Two independent and blinded observers analyzed the EIT data for presence and location of PTX. Analysis of the corresponding CTs by a radiologist served as reference. RESULTS: 87/100 cases had at least one PTX detected by CT. Fourty-two cases showed a PTX > 20% of the sternovertebral diameter (PTXtrans20), whereas 52/100 PTX showed a PTX>3 cm in the craniocaudal diameter (PTXcc3), with 20 cases showing both a PTXtranscc and a PTXcc3. We found a very low agreement between both EIT observers considering the classification overall PTX/noPTX (κ = 0.09, p = 0.183). For PTXtrans20, sensitivity was 59% for observer 1 and 17% for observer 2, with a specificity of 48% and 50%, respectively. For PTXcc3, observer 1 showed a sensitivity of 60% with a specificity of 51% while the sensitivity of observer 2 was 17%, with a specificity of 89%. By programming a semi-automatized detection algorithm, we significantly improved the detection rate of PTXcc3, with a sensitivity of 73% and a specificity of 70%. However, detection of PTXtranscc was not improved. CONCLUSION: In our analysis, visual interpretation of EIT without specific image processing or comparison with baseline data did not allow clinically useful diagnosis of posttraumatic PTX. Multimodal imaging approaches, technical improvements and image postprocessing algorithms might improve the performance of EIT for diagnosing PTX in the future.

Left atrial appendage rupture due to blunt chest trauma in an Eurasian otter (Lutra lutra).

An adult male Eurasian otter, found dead on the roadside, was submitted for post-mortem examination in April 2014 at the Veterinary Pathology Unit of the Faculty of Veterinary Medicine of Teramo, as part of the RECAL [RECovery and post mortem Analysis of Eurasian otters (Lutra lutra) in the National Park of Cilento, Vallo di Diano and Alburni (Salerno, Italy), and surrounding areas] project. Necropsy revealed an abundant hemothorax associated with multifocal, bilateral pulmonary contusions and lacerations, and a severe hemopericardium characterised by the presence of a wide blood clot in the intact pericardial sac. Two small laceration wounds of the left auricle were found at the base, along the atrioventricular groove, and on the outer free wall. Since myocardial and endocardial tissues showed no other gross and histopathological abnormalities, a left atrial appendage rupture resulting from a blunt chest trauma was diagnosed. Blunt traumatic cardiac rupture is a rarely reported, life-threatening condition in humans. To the best of our knowledge, this is the first report on a left atrial appendage rupture due to blunt chest trauma in veterinary literature. The possible occurrence of a cardiac rupture following a blunt thoracic injury should be taken into consideration in veterinary emergency care.

Radiography is less sensitive relative to CT for detecting thoracic radiographic changes in dogs affected by blunt trauma secondary to a motor vehicle accident.

Thoracic injuries caused by blunt trauma are commonly encountered emergencies in veterinary medicine. However, published studies are lacking that compare radiology to CT in blunt trauma caused by motor vehicle accidents in canine patients. The aim of this prospective diagnostic accuracy, methods comparison study were to estimate the sensitivity (Se) and specificity (Sp) of thoracic radiology relative to CT for detecting lung contusions, pneumothorax, pleural effusion, and rib fractures. The study further aimed to develop a severity scoring system for radiology and CT and to compare the findings between the two modalities. The hypothesis was that radiology would be less sensitive than CT at detecting these injuries and that radiology would underestimate the severity of lung contusions. Fifty-nine patients met the inclusion criteria. Radiology underestimated the presence of lung contusions (Se = 69%, 95% confidence interval) and overestimated the severity of the contusions relative to CT. There was high interobserver variability in evaluating lung contusion severity (coefficient of variation = 91%). Both the three-view thoracic and horizontal beam radiography had poor sensitivities for the detecting pneumothorax (Se = 19% and 63%, respectively) and pleural effusions (Se = 43% and 71%, respectively). Similarly, the sensitivity (56%) of radiographs for the detection of rib fractures was poor relative to CT. Findings from the current study indicated that thoracic radiography had low sensitivity for detecting lesions related to blunt thoracic trauma caused by motor vehicle accidents and supported the use of CT as an additional diagnostic imaging modality in these patients.

Association between computed tomographic thoracic injury scores and blood gas and acid-base balance in dogs with blunt thoracic trauma.

OBJECTIVE: To determine the association between thoracic injuries evaluated by computed tomography (CT) and arterial blood gas and acid-base status in dogs with blunt thoracic trauma caused by motor vehicle accidents. DESIGN: Prospective observational clinical study. SETTING: University teaching hospital. ANIMALS: Thirty-one client owned traumatized dogs and 15 healthy dogs. PROCEDURES: All trauma group dogs underwent a CT scan and simultaneous arterial blood gas analysis within 24 hours, but not before 4 hours, after the traumatic incident within a 45-month enrollment period. MEASUREMENTS AND MAIN RESULTS: Thorax injuries were classified as pulmonary, pleural space, or rib cage and each of these components was scored for severity using a CT composite pulmonary, pleural, and rib score. The trauma group arterial blood gas and acid-base status were evaluated for statistical difference from the control group. The pulmonary-arterial oxygen pressure was significantly lower in the trauma group compared to the control group that was supported by significant differences in the calculated variables of arterial blood oxygenation as well. There was also a significant correlation between the composite lung score and pleural score and the variables of arterial oxygen status. The pulmonary-arterial carbon dioxide pressure was not significantly different to any of the thoracic injury variables indicating normal alveolar ventilation. Acid-base imbalances were generally mild, insignificant, and variable. CONCLUSIONS AND CLINICAL RELEVANCE: Blunt thoracic trauma causes significant pulmonary and pleural injury and the blood oxygen economy is significantly affected by this. The functional measures of arterial blood oxygenation were well correlated with thoracic CT pathology. Alveolar ventilation was mostly spared but a clinically significant ventilation perfusion mismatch was present.