Comparison of Clinical and Pathological Diagnoses in Cats and Dogs

Assessment of misdiagnosis in small animal intensive care patients using the Modified Goldman criteria

The postmortem examination can be used as a means of quality control for clinical diagnoses. A retrospective study on 300 dogs and cats that had been admitted to a small animal intensive care unit was performed comparing the clinical and postmortem findings, using the Modified Goldman criteria. All patient files were reevaluated for clinical diagnoses and all postmortem material was reevaluated for pathological diagnoses. After this, the Modified Goldman criteria were applied to score the discrepancies between them, and factors associated with the occurrence of an undiagnosed major unexpected finding were analyzed. The postmortem examination revealed additional findings in 65% of the cases. Major discrepancies, defined as those affecting treatment and possibly outcome of the patient, were present in 21.3% of the cases. The most frequently missed diagnoses detected at necropsy were pneumonia of various etiologies, meningitis/meningoencephalitis, myocarditis and generalized vasculitis. A shorter ICU stay was associated with increased odds of a major discrepancy. Conditions affecting the urinary or gastrointestinal system were negatively associated with major discrepancy.

Veterinary radiologic error rate as determined by necropsy

A large-scale postmortem auditing of antemortem imaging diagnoses has yet to be accomplished in veterinary medicine. For this retrospective, observational, single-center, diagnostic accuracy study, necropsy reports for patients of The Schwarzman Animal Medical Center were collected over a 1-year period. Each necropsy diagnosis was determined to be either correctly diagnosed or discrepant with its corresponding antemortem diagnostic imaging, and discrepancies were categorized. The radiologic error rate was calculated to include only clinically significant missed diagnoses (lesion was not reported but was retrospectively visible on the image) and misinterpretations (lesion was noted but was incorrectly diagnosed). Nonerror discrepancies, such as temporal indeterminacy, microscopic limitations, sensitivity limitations, and study-type limitations were not included in the error rate. A total of 1099 necropsy diagnoses had corresponding antemortem imaging; 440 diagnoses were classified as major diagnoses, of which 176 were discrepant, for a major discrepancy rate of 40%, similar to reports in people. Seventeen major discrepancies were diagnoses that were missed or misinterpreted by the radiologist, for a calculated radiologic error rate of 4.6%, comparable with error rates of 3%-5% reported in people. From 2020 to 2021, nearly half of all clinically significant abnormalities noted at necropsy went undetected by antemortem imaging, though most discrepancies owed to factors other than radiologic error. Identifying common patterns of misdiagnosis and discrepancy will help radiologists refine their analysis of imaging studies to potentially reduce interpretive error.

Lesions and pathogens found in pigs that died during the nursery period in five Danish farms

BACKGROUND

Diagnosing and treatment of diseases in pigs are important to maintain animal welfare, food safety and productivity. At the same time antimicrobial resistance is increasing, and therefore, antibiotic treatment should be reserved for individuals with a bacterial infection. The aim of the study was to investigate gross and histological lesions and related pathogens in pigs that died during the nursery period in five Danish farms. In addition, high throughput, real-time qPCR monitoring of specific porcine pathogens in fecal sock and oral fluid samples were carried out to investigate the between-farm and between-batch variation in the occurrence of pathogens.

RESULTS

Twenty-five batches of nursery pigs from five intensive, indoor herds were followed from weaning (approximately four weeks) to the end of nursery (seven to eight weeks post weaning). Gross and histological evaluation of 238 dead and 30 euthanized pigs showed the highest prevalence of lesions in the skin, respiratory system, gastrointestinal tract, and joints. Gross and histological diagnoses of lung and joint lesions agreed in 46.5% and 62.2% of selected pigs, respectively. Bacteriological detection of Escherichia coli, Streptococcus suis or Staphylococcus aureus infections in joints, lungs and livers was confirmed as genuine infection on immunohistochemical staining in 11 out of 70 tissue sections. The real-time qPCR analysis of pooled samples showed that most pathogens detected in feces and in oral fluid in general followed the same shedding patterns in consecutive batches within herds.

CONCLUSIONS

Gross assessment should be supplemented with a histopathological assessment especially when diagnosing lesions in the lungs and joints. Moreover, microbiological detection of pathogens should optimally be followed up by in situ identification to confirm causality. Furthermore, routine necropsies can reveal gastric lesions that may warrant a change in management. Real-time qPCR testing of fecal sock samples and oral fluid samples may be used to monitor the infections in the individual herd and testing one batch seems to have a good predictive value for subsequent batches within a herd. Overall, optimal diagnostic protocols will provide a more substantiated prescription of antibiotics.

Miniature Schnauzers under primary veterinary care in the UK in 2013: demography, mortality and disorders

Background

Individual dog breeds are often reported as predisposed to specific breed-related disorders but reliable epidemiological data on disease prevalence are sparse. The Miniature Schnauzer in the UK is a popular small breed dog that is often considered as relatively healthy and long-lived, but is this really true? This study aimed to use data from the VetCompass™ Programme at the Royal Veterinary College to characterise the demography, mortality and common disorders of the general population of Miniature Schnauzers under veterinary care in the UK.

Results

The study population of 455,557 dogs from 304 clinics in the VetCompass™ database under veterinary care during 2013 included 3857 Miniature Schnauzers (0.85%). For dogs with data available, 1771 (56.9%) were neutered and 1893 (49.2%) were females. Mean adult bodyweight overall was 9.9 kg (SD 2.2 kg) and median longevity was 11.6 years (IQR 9.3–13.1, range 0.5–17.0). The most prevalent fine-level precision disorders recorded were periodontal disease (n = 343, prevalence 17.4, 95% CI: 15.7–19.1), obesity/overweight (164, 8.3, 95% CI: 7.1–9.6), anal sac impaction (114, 5.8, 95% CI: 4.8–6.9), vomiting (100, 5.1, 95% CI% 4.1–6.1) and otitis externa (99, 5.0, 95% CI% 4.1–6.1). The most prevalent grouped-level precision disorders were dental (n = 378, prevalence: 19.2, 95% CI: 17.5–21.0), enteropathy (270, 13.7, 95% CI: 12.2–15.3), cutaneous (250, 12.7, 95% CI: 11.2–14.2) and aural (197, 10.0, 95% CI: 8.7–11.4).

Conclusions

This study provides generalisable evidence on the demography, longevity and most prevalent disorders in the Miniature Schnauzer breed in the UK. Awareness of common diseases and breed predispositions can support evidence-based policies to improve breed health, guide veterinary surgeons when producing differential diagnosis lists, and assist owners when purchasing or caring for their pets.