A scoping review on intraoperative and postoperative surgical castration complications in domesticated equids.

BACKGROUND: Castration is the most common surgical procedure in domesticated equids; surgical techniques used and perioperative management vary considerably. OBJECTIVES: To identify and chart the current evidence on perioperative complications associated with different methods of surgical castration in domesticated equids. STUDY DESIGN: Joanna Briggs Institute systematic scoping review. METHOD: CAB Abstracts, Medline and Embase databases were searched using terms related to equine castration complications. Two authors independently and blindly screened publications against eligibility criteria. Data on study methods, perioperative management, surgical techniques, and perioperative complications were extracted. Surgical techniques were grouped into categories depending on technique; open, closed or half-closed, and whether the parietal tunic was open or closed at the end of surgery. RESULTS: The search identified 1871 publications; 71 studies met the final inclusion criteria. The data reported 76 734 castrations, most of which were open or closed, with the vaginal tunic remaining open at the end of surgery. Twenty-five studies reported information regarding surgical techniques and perioperative management, allowing detailed charting and comparisons, of which analgesia and antimicrobial usage varied notably. Eighteen different complications were reported, with swelling or oedema being the most common. Evisceration was most commonly reported in draught breeds and Standardbreds, and the risk appeared low if the parietal tunic was closed at the end of surgery. MAIN LIMITATIONS: Grey literature and studies not available in English were not included. Existing studies varied greatly in perioperative management, surgical techniques and reporting of outcomes, making evidence consolidation problematic. CONCLUSION: A lack of consensus regarding complication definitions creates uncertainty and discrepancies between complication rates associated with different surgical techniques and perioperative management. The implementation of standardised systems for describing surgical techniques and complications is recommended for future studies. A number of studies did not follow current recommendations for perioperative analgesia and use of antimicrobials.

Multicenter study investigating long-term survival after synovial lavage of contaminated and septic synovial structures in horses presented to 10 UK referral hospitals.

OBJECTIVE: To report the long-term survival of adult horses that were subjected to synovial lavage for treatment of contaminated and septic synovial structures. STUDY DESIGN: Multicenter, prospective observational trial. ANIMALS: Horses (n = 240) presented for synovial sepsis at 10 UK referral centers. METHODS: Data for horses presented for treatment of synovial sepsis were collected over a 15 month recruitment period. Owners were contacted a minimum of 365 days after surgery using a structured client interview to assess long term survival. Descriptive statistics, and univariable and Cox proportional hazards models for postoperative survival time were developed. RESULTS: Survival to discharge was 228/240 (95%) and overall long-term survival was 89.4% (185/207). Unknown cause of injury (p = .017), increasing duration of surgery (p = .003), increasing weight (p = .008), forelimb injuries (p = .027), and type of synovial structure (p = .008) were found to be associated with death using Cox proportional hazards models. CONCLUSION: This study provides information on risk factors associated with survival and death after treatment for synovial sepsis at referral hospitals in the UK. Survival to discharge and long-term survival was excellent. Heavier horses, injuries affecting the forelimbs, tendon sheaths and bursae were associated with poorer long term outcomes. Longer duration of surgery was also found to be associated with a worse prognosis. CLINICAL SIGNIFICANCE: These findings help to provide prognostic information for owners and veterinarians treating horses with synovial sepsis.

UK horse owners and veterinary practitioners' experiences of decision-making for critical cases of colic.

BACKGROUND: The survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision-making by the owner and veterinary practitioner. OBJECTIVES: To explore UK horse owners' and veterinary practitioners' experiences of decision-making for critical cases of equine colic. STUDY DESIGN: Qualitative study using a phenomenological approach. METHODS: Individual, semi-structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A purposive, convenience sample of participants was recruited. Sessions explored participant's experience of colic, including recognition, help-seeking behaviour, and challenges. Thematic analysis was performed on collected data. RESULTS: Four over-arching themes were identified; 'head', 'heart', 'practicalities' and 'impact'. Owners acknowledged responsibility for their horse's welfare but had different perspectives than vets on the importance of finance ('head'). Both vets and owners described how the horse-human relationship ('heart') often led to conflict during decision-making. The vet-client relationship was influential on decision-making for both owners and vets; involving other people in decision-making was described both positively and negatively by participants ('heart'). 'Practicalities', such as lack of preparedness, transport issues and adverse weather conditions, were identified by both owners and vets as barriers. Owners described a 'rollercoaster' of emotions after a critical decision, with profound impacts on their mental wellbeing, feelings of guilt, and long-term changes in behaviour ('impact'), and a lack of support to manage these feelings. MAIN LIMITATIONS: Small sample size. CONCLUSIONS: This study describes stakeholder decision-making during critical cases of equine colic. Factors that commonly influenced decisions included an owner's previous knowledge and beliefs, social pressures, logistics and the relationship between the owner and vet. The study highlighted long-term impacts on the owner, including their management and decisions for subsequent horses. These factors should be considered in shared decision-making.

Prospective case study of critical decision making for horses referred for treatment of colic.

BACKGROUND: There is limited evidence on factors affecting critical decision making for horses with colic. This study's aim was to describe the assessment and decision making involved in horses referred for management of colic. METHODS: An in-depth case analysis was used to document case presentation, decision making and outcomes for horses referred for colic to two UK equine veterinary practices over a 12-month period. The data recorded included previous history, presenting signs, response to treatment, case outcome and factors affecting decisions for further treatment or euthanasia. RESULTS: Data were available for 60 cases: 55 were hospitalised for medical or surgical treatment and five horses were euthanased following initial assessment. The main factors affecting treatment decisions were severity of clinical signs (80%, 47/59), financial concerns (10%, 6/59) and ongoing health issues or previous history of colic (5%, 3/59). Factors associated with euthanasia decisions were postoperative complications (5/18), poor prognosis (4/18), deteriorating clinical signs (3/18) and financial concerns (3/18). LIMITATION: The limited study population may affect the extent to which the findings can be generalised. CONCLUSION: The severity of clinical signs was the key factor in treatment decision making. The main factors affecting euthanasia decisions were clinical deterioration, poor prognosis and financial constraints. These findings should be incorporated into clinical case recording to capture the multifactorial nature of decision making.

Scoping review of end-of-life decision-making models used in dogs, cats and equids.

BACKGROUND: End-of-life decisions for companion animals can be stressful for veterinarians and owners, and when delayed result in poor animal welfare. Delayed euthanasia has been identified as a particularly prominent issue for horses. This scoping review aimed to identify the available literature on veterinary decision-making models, which can support end-of-life planning. METHODS: A protocol was preregistered, and a structured literature search was performed on six electronic databases. Publications were reviewed against specifically developed eligibility criteria. Data from original studies and narrative-type reviews were extracted separately, and the components of each model were charted. RESULTS: A total of 2211 publications were identified, 23 met the inclusion criteria and were included in the final review. Eight were original research studies and 15 were narrative reviews or similar. Publications were not indexed uniformly, increasing the difficulty of discovering relevant sources. The end-of-life decision-making process comprised three stages: (1) making the decision, (2) enacting the decision and (3) aftercare. Twenty key components of decision-making models were identified, although no publication reflected all of these. CONCLUSIONS: A lack of original research studies and equine-specific publications was identified. Shared decision-making models for euthanasia in veterinary practice should include all three stages and consider species-specific issues.

A scoping review of the current evidence on treatment and outcomes following synovial sepsis.

BACKGROUND: Synovial sepsis is a frequent cause of morbidity and mortality in horses. Despite advances in diagnostics and treatments, persistent infection or chronic lameness can occur. OBJECTIVES: To perform a scoping review to identify and evaluate the current evidence on the factors implicated in the success of treatment for synovial sepsis. STUDY DESIGN: Joanna Briggs Institute scoping review. METHODS: A protocol was registered, and a systematic literature search was performed on CAB abstracts, Medline, Scopus and Embase. Inclusion and exclusion criteria were developed and studies systematically reviewed against this. Studies relating to factors affecting treatment success following synovial sepsis were retained and data was extracted on study method, population characteristics and factors significantly associated with treatment outcome. RESULTS: In total, 2338 studies were identified, and 61 were included to full paper analysis. Eight papers reported significant factors, identifying 15 risk factors associated with two measurements of outcome, either survival and/or return to athletic function. The 15 factors were identified and categorised into pre-, intra- and post-operative factors. Risk factors that were identified included the number or type of synovial structures involved, the presence of pannus, tendon and bone pathology, and the use of systemic antimicrobials. There were many discrepancies in inclusion criteria of cases of synovial sepsis as well as measurement and description of outcome variables. MAIN LIMITATIONS: Non-English language studies or conference proceedings were not included. Only small numbers of papers had similar findings. CONCLUSIONS: Standardisation of inclusion criteria is essential to enable comparisons and analysis between studies on synovial sepsis. Future studies should use methodologies to reduce bias including multicentre and multinational studies, prospective study design and robust statistical modelling.

Developing consensus for definitions of key veterinary-specific quality improvement (QI) terms using an eDelphi-study method.

BACKGROUND: Quality improvement (QI) methods are a continuous process of iterative tests to improve the quality of a service or product. Using common language has been linked to the successful implementation of QI in human healthcare. This study aimed to assimilate and achieve consensus on veterinary-specific definitions for terms associated with quality care and QI methods in UK veterinary practice. METHODS: A four-round modified eDelphi process with a panel of 50 UK veterinary practice stakeholders was used to generate consensus. The panel selected or suggested the definition they best felt 'fitted' each term. Consensus was reached if there was >70% agreement, and terms were eliminated if there was <15% selection. RESULTS: Thirty-one panellists completed all three rounds of eDelphi; eight participants completed an optional feedback round. From 14 terms, 10 reached consensus, leaving four unresolved definitions. CONCLUSIONS: A majority of terms reached consensus; 90% were new or amended definitions proposed by panel members. Utilising plain English refined by stakeholders will allow successful implementation of QI in veterinary healthcare. Not all terms achieved consensus, highlighting a need for further research to enable successful integration of QI principles as seen in human healthcare.

Owners' Knowledge and Approaches to Colic in Working Equids in Honduras.

In Honduras, many families are reliant on working equids in their daily life. The aim of this study was to evaluate knowledge about, and approaches to colic used by owners of working equids in Choluteca, Honduras using a phenomenological approach. Semi-structured, verbal questionnaires were conducted with ninety-three owners from eleven different communities in the Choluteca region on equid horse owners' knowledge of colic and treatments. Additional context was gained through observations and verbal questionnaires with three veterinary practitioners and eight agricultural pharmacy (agrovet) store owners. Working equids were commonly used for firewood collection 31% (40/126), transportation 24% (30/126), and carrying crops 13% (17/126). Thirty-eight percent of owners (35/92) said they did not know what colic was, 27% (24/89) could not name any clinical signs, and 46% (42/92) could not name any causes. Most owners with previous experience of colic had treated it themselves 79% (53/67), typically using herbal remedies. Colic was a major concern for owners of working equids who had prior experience or knowledge of the condition. Knowledge and understanding of colic varied, and access to evidence-based treatments was very limited. The findings will be used to inform the development of educational resources on colic in working equids.

The Impact of COVID-19 on the Working Equid Community: Responses from 1530 Individuals Accessing NGO Support in 14 Low- and Middle-Income Countries.

The COVID-19 pandemic was declared on 11 March 2020. The working equid community includes some of the world's most marginalised people, who rely on animals for their daily lives and livelihoods. A cross-sectional study investigated the effects of COVID-19 on working equid communities, with the intention of developing methods for replication in future unprecedented events. A multi-language survey was developed, involving 38 predominantly closed questions, and carried out face-to-face, over telephone, or online. There were 1530 respondents from a population of individuals who received support from equid welfare projects across 14 low- or middle-income countries projects during November and December 2020. Overall, at the time of survey completion, 57% (875/1522) of respondents reported that their equids were working less, 76% (1130/1478) reported a decreased monthly income from equids, and 78% (1186/1519) reported a reduction in household income compared to pre-pandemic levels. Costs of equid upkeep remained the same for 58% (886/1519) of respondents and 68% (1034/1518) reported no change in the health of their equid. The potential long-term impacts on human and equid welfare due to reported financial insecurities necessitates monitoring. A One Welfare approach, involving collaboration with governments, humanitarian, and animal welfare non-governmental organisations is required to mitigate deep-rooted issues.

Qualitative study of the influence of horse-owner relationship during some key events within a horse's lifetime.

BACKGROUND: There is a lack of research exploring how the horse-human relationship influences horse owners' decision-making. The aim of this study was to investigate how an owner's relationship with their horse affects decisions around key events during their horse's lifetime. METHODS: An online survey and semi-structured telephone interviews were conducted with horse-owners. The online survey asked horse owners about their experiences of decision-making and their relationship with their horse and identified interview participants. Two semi-structured interviews were conducted with 11 horse owners on their experience of purchasing and euthanasia of horses. Interviews were recorded and transcribed, and thematic analysis was performed. RESULTS: There were 938 responses to the online survey. The majority of owners considered their horse to be a member of the family (92.9%, 808/870). The mean amount spent annually on their horse was £9215 (range £324-14,240). Seven themes were identified in the interviews including mismatching of horse and rider; financial, time, welfare and personal obligations involved in horse ownership; shared-decision making; the horse's quality of life; guilt and responsibility grief surrounding euthanasia decisions. CONCLUSION: This study highlighted the strong owner-horse relationship, the significant obligations involved in horse ownership and the emotional impact of euthanasia decisions.

Cross-sectional study of UK horse owner's purchase and euthanasia decision-making for their horse.

BACKGROUND: This cross-sectional study aimed to investigate factors affecting horse owners' purchase and euthanasia decisions that had been identified in a qualitative study. METHODS: An online survey on horse owners' purchase and euthanasia decisions and experiences was distributed using snowball sampling. Inclusion criteria were previous experience of purchase or euthanasia decisions. Descriptive data analyses (mean, median, mode and frequency percentages) were performed. RESULTS: There were 451 participants from the UK and Ireland, 97% were female with a median age of 45 years. Participants most frequently did not seek any advice when deciding what type of horse to purchase (38.6%, 169/438) or if it was priced appropriately (48.7%, 214/439). Most participants were satisfied with their purchase and would purchase their horse again (84.9%, 370/436). The most frequent reasons for euthanasia were injury/illness with low chance of survival (55.2%, 201/364), poor quality of life (42.6%, 155/363) and long-term injury (35.7%, 130/364). Most participants sought advice or guidance when making end-of-life decisions (87.5%, 328/375), and 55% (243/440) had a euthanasia plan in place. CONCLUSIONS: Owners show limited advice-seeking behaviour on key aspects of purchase decisions. Owners frequently seek advice on euthanasia decisions, and the majority of decisions were based on welfare concerns.

Ultrasonographic evaluation of the width, thickness, and length of the normal linea alba in standing and dorsal recumbent horses.

OBJECTIVE: To determine the variability in length, width, and thickness of the equine linea alba (LA) and the effect of a standing vs dorsal recumbent position on these measurements. STUDY DESIGN: Descriptive anatomical comparative study. ANIMALS: Standing horses (N = 75; in 30 horses, measurements were obtained in dorsal recumbency first and repeated after horses were standing). METHODS: Linea alba length was measured in standing position from xiphoid to umbilicus, and transverse ultrasonographic images were obtained at five reference points to measure LA width and thickness. In 30 horses, measurements were obtained in dorsal recumbency first and repeated after horses were standing. RESULTS: There was wide variation in LA width and thickness between standing horses, with gradual increase from xiphoid (range, 0.14-0.64 cm) to umbilicus (range, 0.2-2.97 cm). Linea alba length in standing position was 51.09 ± 6.219 cm. Width was independent of the size of the horse; thickness and length were correlated at some reference points to height (r = 0.346-585, P < .05) and weight (r = 0.324-0.642, P < .05). Different LA shapes could be identified. In dorsal recumbency, the LA was smaller in width at all reference points (15%-23%, P < .05) and shorter (20%, P < .001) compared with standing. CONCLUSION: In addition to the wide variability in LA measurements and shapes between horses, there was a significant decrease in LA width and length when horses changed from standing to dorsal recumbency. CLINICAL SIGNIFICANCE: The difference in LA length and width between dorsal recumbency and when standing could increase tension on sutures after laparotomy and should be taken into account when surgeons are closing the abdomen.

Mixed methods investigation of the use of telephone triage within UK veterinary practices for horses with abdominal pain: A Participatory action research study.

BACKGROUND: Telephone triage is an integral part of modern patient care systems in human medicine, and a key component of veterinary practice care systems. There is currently no published research on telephone triage within the veterinary profession. OBJECTIVE: To investigate current approaches to telephone triage of horses with abdominal pain (colic) in veterinary practice and develop new resources to support decision-making. STUDY DESIGN: Participatory action research using mixed-methods approach. METHODS: An online survey assessed current approaches to telephone triage of horses with colic in UK veterinary practices. Structured group and individual interviews were conducted with four equine client care (reception) teams on their experiences around telephone triage of colic. Evidence-based resources, including an information pack, decision flow chart and recording form, were developed and implemented within the practices. Participant feedback was obtained through interviews six months after implementation of the resources. RESULTS: There were 116 participants in the online survey. Management and client care staff (53/116) felt less confident giving owner advice (p<0.01) and recognising critical indicators (p = 0.03) compared to veterinary surgeons and nurses (63/116). Thirteen themes were identified in the survey relating to owner advice; exercise and owner safety were most frequently mentioned, but conflicting guidance was often given. Fourteen client care staff were interviewed. They were confident recognising colic during a telephone conversation with an owner and identified the most common signs of critical cases as sweating and recumbency. The new resources received positive feedback; the decision flow chart and information on critical indicators were identified as most useful. After resource implementation, there was an increase in confidence in recognising critical cases and giving owners advice. MAIN LIMITATIONS: Limited sample population. CONCLUSIONS: This study described existing approaches to telephone triage, identified variations in advice given, and worked with client care teams to develop new resources to aid decision-making.

Indicators of 'critical' outcomes in 941 horses seen 'out-of-hours' for colic.

BACKGROUND: This study aimed to describe the presentation and outcomes of horses with signs of colic (abdominal pain) seen 'out-of-hours' in equine practice. METHODS: This was a retrospective study of horses seen 'out-of-hours' with colic by two equine veterinary practices between 2011 and 2013. Case outcomes were categorised as 'critical' or 'not critical'. A critical outcome was defined as requiring medical or surgical hospital treatment, or resulting in euthanasia or death. A non-critical outcome was defined as resolving with simple medical treatment. A hierarchical generalised linear model was used to identify 'red flag' parameters (aspects of signalment, history and presenting clinical signs) associated with critical outcomes. RESULTS: Data were retrieved from 941 cases that presented with colic; 23.9 per cent (n=225/941) were critical. Variables significantly associated with the likelihood of a critical outcome in the final multivariable model were increased heart rate (P<0.001), age of the horse (P=0.013) and abnormal mucous membrane colour (P<0.001). Overall 18 per cent (n=168/941) of cases were euthanased. CONCLUSIONS: This study highlights the mortality associated with colic. The 'red flag' parameters identified should be considered an essential component of the primary assessment of horses with colic.

Retrospective case series to identify the most common conditions seen 'out-of-hours' by first-opinion equine veterinary practitioners.

BACKGROUND: The study aim was to describe conditions seen 'out-of-hours' in equine practice. METHODS: This was a retrospective case series of first opinion 'out-of-hours' cases seen at two equine practices between 2011 and 2013. Data were retrieved on case presentation, diagnostic testing, treatment administered and outcome, and diseases categorised using a systems-based coding system. A hierarchical logistic regression, formulated using a generalised linear model, was used to identify clinical variables associated with a binary outcome of 'critical' cases (required hospitalisation or euthanasia or died). RESULTS: Data from 2602 cases were analysed. The most common reasons for 'out-of-hours' visits were colic (35 per cent, n=923/2620), wounds (20 per cent, n=511/2620) and lameness (11 per cent, n=288/2,620). The majority of cases required a single treatment (58 per cent, n=1475/2550), 26 per cent (n=656/2550) needed multiple treatments and 13 per cent (n=339/2550) were euthanased. Eighteen per cent (n=480/2602) of cases had a critical outcome. Increased heart rate at primary presentation was associated with critical outcome in both practices (Practice A, OR 1.07 (95 per cent confidence interval 1.06 to 1.09), Practice B OR 1.08 (95 per cent confidence interval 1.07 to 1.09; p<0.001)). CONCLUSION: Colic, wounds and lameness were the most common equine 'out-of-hours' conditions; 13 per cent of cases were euthanased. Further research is required into out-of-hours euthanasia decision-making.

Use of smartphones to aid the teaching of equine ocular fundus examination.

BACKGROUND: Teaching and learning how to perform examination of the ocular fundus is challenging. Smartphones can support to enhance students' confidence and experience. METHODS: Following an optional year-4 ophthalmoscopy practical using hand-held ophthalmoscopes, students completed a questionnaire using a visual analogue scale (VAS) investigating if students felt smartphone use aided learning and if student's self-assessed confidence in visualising the ocular fundus had improved. VAS scores were compared using the Wilcoxon signed rank test (significance: P<0.05). RESULTS: All 30 year-4 students attending the practical participated to the study. Confidence in performing direct ophthalmoscopy significantly increased after the practical. Confidence after the practical was 65.3 (±19.8) per cent compared with before the practical when confidence was 20.1 (±15.6) per cent (P<0.001). The perceived usefulness of traditional teaching was 62.3 (±23.8) per cent. The perceived usefulness of the teaching with the smartphone was 91.1 (±8.6) per cent. While students found both methods useful, they perceived the use of the smartphone to be significantly more useful (P<0.001). Free-text comments on the use of the smartphone were all positive and included 'useful', 'fun' and 'good teaching tool'. CONCLUSIONS: This study shows that students positively received the use of the smartphone, which can be a useful tool to teach the equine ocular examination to undergraduate veterinary students.

Risk factors for acute abdominal pain (colic) in the adult horse: A scoping review of risk factors, and a systematic review of the effect of management-related changes.

Acute abdominal pain (colic) is the most common reason for emergency veterinary treatment in the horse. Consolidation of data through a systematic review is important to inform evidence-based medicine and clinical guidelines, but there are currently no published systematic reviews on colic in the horse. The aim of this study was to identify, categorize and appraise the evidence on factors associated with increased risk of developing abdominal pain (colic) due to gastrointestinal disease in the adult horse. A scoping review was performed to identify and categorize evidence on all risk factors for colic. A systematic review of management-related risk factors was then performed following PRISMA guidelines. Both searches were conducted in Medline, CAB Abstracts and Web of Science databases, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. For the systematic review, cohort, case-control or cross-sectional studies investigating acute abdominal pain in horses within two weeks of management changes were assessed. Study characteristics, participant characteristics and study results of included publications for the systematic review were extracted and tabulated. Included publications were appraised using the Joanna Briggs Institute Critical Appraisal Tools for cohort, case-control and cross-sectional studies. The scoping review search identified 3,756 publications. Fifty eight studies met final inclusion criteria, and 22 categories of risk factors were identified. These were grouped into three broad areas: horse-related factors, management-related factors and environment-related factors. The largest body of evidence related to management change. The systematic review of management change identified 410 publications: 14 met inclusion criteria for analysis. These consisted of one cohort, eight case-control and five cross-sectional studies. The studies were conducted between 1990-2008, and the majority of studies were located in the USA (8/14) or UK (3/14). The risk factors related to management change that were assessed were feed, carer, exercise, pasture, water and housing. The largest bodies of evidence for increased risk of colic associated with management change were changes in feed (5/14 publications) and recent change in housing (3/14). Most studies (8/14) did not meet the JBI criterion on confounding factors. There was marked heterogeneity of study methodologies and measures. This is the first study to use a combined scoping and systematic review to analyse evidence for modifiable risk factors for a common condition in the horse. It provides a comprehensive review that will be a key resource for researchers, veterinary practitioners and horse owners. It identified modifiable risk factors associated with an increased risk of colic which should be a key target for preventative health programmes. The findings from the critical appraisal were used to develop recommendations for future research to improve the quality of evidence-based veterinary medicine.

Prospective study of the primary evaluation of 1016 horses with clinical signs of abdominal pain by veterinary practitioners, and the differentiation of critical and non-critical cases.

BACKGROUND: The majority of research on the evaluation of horses with colic is focused on referral hospital populations. Early identification of critical cases is important to optimise outcome and welfare. The aim of this prospective study was to survey the primary evaluation of horses with clinical signs of abdominal pain by veterinary practitioners, and compare the initial presentation of critical and non-critical cases. RESULTS: Data from 1016 primary evaluations of horses presenting with clinical signs of colic were submitted by 167 veterinary practitioners across the United Kingdom over a 13 month period. The mean age of the study population was 13.5 years (median 12.0, range 0-42). Mean heart rate on primary presentation was 47 beats/min (median 44, range 18-125), mean respiratory rate was 20 breaths/min (median 16, range 6-100), and median gastrointestinal auscultation score (0-12, minimum-maximum) was 5 (range 0-12). Clinical signs assessed using a behavioural severity score (0-17, minimum-maximum), were between 0 and 6 in 70.4 % of cases, and 7-12 for 29.6 % of cases. Rectal examination was performed in 73.8 % of cases. Cases that responded positively to simple medical treatment were categorised retrospectively as 'non-critical'; cases that required intensive medical treatment, surgical intervention, died or were euthanased were categorised as 'critical'. Eight-hundred-and-twenty-two cases met these criteria; 76.4 % were 'non-critical' and 23.6 % were 'critical'. Multivariable logistic regression was used to identify features of the clinical presentation associated with critical cases. Five variables were retained in the final multivariable model: combined pain score: (OR 1.19, P < 0.001, 95 % CI 1.09-1.30), heart rate (OR 1.06, P < 0.001, 95 % CI 1.04-1.08), capillary refill time >2.5 s (OR 3.21, P = 0.046, 95 % CI 1.023-10.09), weak pulse character (OR 2.90, P = 0.004, 95 % CI 1.39-5.99) and absence of gut sounds in ≥1 quadrant (OR 3.65, P < 0.001, 95 % CI 2.08-6.41). CONCLUSIONS: This is the first study comparing the primary presentation of critical and non-critical cases of abdominal pain. Pain, heart rate, gastrointestinal borborygmi and simple indicators of hypovolaemia were significant indicators of critical cases, even at the primary veterinary examination, and should be considered essential components of the initial assessment and triage of horses presenting with colic.

Prospective survey of veterinary practitioners' primary assessment of equine colic: clinical features, diagnoses, and treatment of 120 cases of large colon impaction.

BACKGROUND: Large colon impactions are a common cause of colic in the horse. There are no scientific reports on the clinical presentation, diagnostic tests and treatments used in first opinion practice for large colon impaction cases. The aim of this study was to describe the presentation, diagnostic approach and treatment at the primary assessment of horses with large colon impactions. METHODS: Data were collected prospectively from veterinary practitioners on the primary assessment of equine colic cases over a 12 month period. Inclusion criteria were a diagnosis of primary large colon impaction and positive findings on rectal examination. Data recorded for each case included history, signalment, clinical and diagnostic findings, treatment on primary assessment and final case outcome. Case outcomes were categorised into three groups: simple medical (resolved with single treatment), complicated medical (resolved with multiple medical treatments) and critical (required surgery, were euthanased or died). Univariable analysis using one-way ANOVA and Tukey's post-hoc test, Kruskal Wallis with Dunn's post-hoc test and Chi squared analysis were used to compare between different outcome categories. RESULTS: 1032 colic cases were submitted by veterinary practitioners: 120 cases met the inclusion criteria for large colon impaction. Fifty three percent of cases were categorised as simple medical, 36.6% as complicated medical, and 9.2% as critical. Most cases (42.1%) occurred during the winter. Fifty nine percent of horses had had a recent change in management, 43% of horses were not ridden, and 12.5% had a recent / current musculoskeletal injury. Mean heart rate was 43 bpm (range 26-88) and most cases showed mild signs of pain (67.5%) and reduced gut sounds (76%). Heart rate was significantly increased and gut sounds significantly decreased in critical compared to simple medical cases (p<0.05). Fifty different treatment combinations were used, with NSAIDs (93%) and oral fluids (71%) being administered most often. CONCLUSIONS: Large colon impactions typically presented with mild signs of colic; heart rate and gut sounds were the most useful parameters to distinguish between simple and critical cases at the primary assessment. The findings of seasonal incidence and associated management factors are consistent with other studies. Veterinary practitioners currently use a wide range of different treatment combinations for large colon impactions.