Admission base excess as a predictor of transfusion requirement and mortality in dogs with blunt trauma: 52 cases (2007-2009)

Abdominal fluid score as a predictor of transfusion needs and outcome in cats following trauma

OBJECTIVE

To assess the value of the abdominal fluid score (AFS) in cats following trauma in determining surgical needs, transfusion needs, and mortality.

DESIGN

Multicenter retrospective observational study utilizing data from the Veterinary Committee on Trauma (VetCOT) registry.

SETTING

VetCOT Veterinary Trauma Centers.

ANIMALS

A total of 2309 cats entered into the VetCOT registry between January 1, 2013, and December 31, 2020, were included.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of the included cats, 148 had abdominal effusion on presentation (AFS 1-4, positive AFS [pAFS]). pAFS cats demonstrated a lower total plasma protein (6.2 g/dL, range: 2.8-9.2 g/dL vs 6.8 g/dL, range: 2.6-11 g/dL, P < 0.001) and a more negative base excess (BE) (-9, range: -23.7 to 10 vs -6.1, range: -31.7 to 1, P = 0.001) than cats without abdominal effusion (negative AFS [nAFS]). pAFS cats also had a higher baseline Animal Trauma Triage score (ATTS) than nAFS cats (5, range 0-12 vs 3, range 0-17, respectively, P < 0.001). pAFS cats were more likely to require blood transfusions (16% [23/148] vs 4% [94/2161], P < 0.001) than nAFS cats, but need for surgical intervention did not differ between groups. A pAFS was associated with increased need for hospitalization (62.8% [93/148] vs 47.7% [1030/2160], P < 0.001), but length of hospital stay did not differ. Cats with pAFS experienced higher mortality compared to nAFS cats (42.6% [63/148] vs 22.7% [491/2161], P < 0.001).

CONCLUSION

The presence of abdominal effusion in cats following trauma was associated with increased morbidity in this study, as demonstrated by greater need for transfusion, increased likelihood of hospitalization, and greater mortality. Cats in the pAFS group had more negative BE and higher ATTS, but need for surgery, length of hospitalization, PCV, and blood glucose, plasma lactate, and ionized calcium concentrations were not different between groups.

Acid-base and electrolyte changes in dogs after packed red blood cell transfusion

BACKGROUND

Packed RBC (pRBC) transfusions are often necessary to enhance organ perfusion and tissue oxygenation in cases of severe anemia.

OBJECTIVES

We aimed to describe changes in acid-base and biochemical parameters in dogs after transfusion of pRBC and potential effects on the outcome.

METHODS

The prospective observational study included anemic dogs requiring pRBC transfusions. Venous blood gas and electrolytes were measured pre-transfusion and repeated within 1 h post-transfusion. Signalment, pre-existing conditions and underlying disease(s), number of days spent of hospitalization, the quantity of transfused pRBC units, and the outcome were also recorded. Associations between analytical values and all other parameters before and after transfusion were assessed using the Wilcoxon test. A generalized linear model was generated for each of the blood gas parameters post-transfusion, including the pre-transfusion values and the characteristics of the animal as fixed effects. The effect of the blood gas parameters on the mortality and hospitalization length was assessed using logistic regression and generalized linear models, respectively.

RESULTS

Twenty-six dogs with different causes of anemia were included in the study, with dogs remaining hospitalized for a median of 3 days (range: 0-11). Pre-transfusion heart rate, respiratory rate, Angap, base excess, and lactate were higher than post-transfusion values. Post-transfusion results showed an increase in hematocrit, hemoglobin, HCO3-, PCO2, tCO2, and chloride. Pre-transfusion hypophosphatemia and receiving an increased volume of transfused pRBC were associated with a longer hospital stay, while higher pre-transfusion lactate values were associated with higher mortality.

CONCLUSIONS

pRBC transfusion in anemic dogs was associated with an improvement in perfusion and acid-base parameters. Pre-transfusion lactate may be an indicator of mortality in dogs.

Evaluation of the Trauma-Associated Severe Hemorrhage score as a predictor of transfusion in traumatized dogs

OBJECTIVE

To retrospectively study the use of the human-based Trauma-Associated Severe Hemorrhage (TASH) score to predict transfusion needs and outcome in a population of traumatized dogs.

MEASUREMENTS AND MAIN RESULTS

The TASH score (comprising sex, hemoglobin concentration, systolic blood pressure, abdominal effusion, heart rate, base excess [BE], and presence of pelvic/femoral fractures) was applied to 24 dogs presenting to a private veterinary hospital following trauma: 12 dogs that required transfusion of blood products and 12 age- and weight-matched controls that did not. Dogs that required transfusions demonstrated a significantly higher TASH score compared with dogs that did not (10.2 ± 2.0 vs 5.2 ± 1.1, respectively; P = 0.03). Univariate analyses of individual TASH score components demonstrated significant differences between animals that received a transfusion and those that did not in BE (median: -8.6 [range: -14.4 to 1.4] vs -4.5 [range: -15.4 to -0.4], respectively; P = 0.04) and positive abdominal fluid score (4/12 vs 0/12, respectively; P = 0.03). The Animal Trauma Triage scores (ATTSs) for dogs included in the study were also obtained from the Veterinary Committee on Trauma registry. The mean ATTS was significantly higher in dogs that received blood transfusions than those that did not (5.2 ± 0.78 vs 2.0 ± 0.5, respectively; P = 0.003).

CONCLUSIONS

The TASH score may be useful to predict transfusion needs in a larger population of traumatized canine patients.

Retrospective evaluation of admission total plasma protein as a predictor of red blood cell transfusion requirement in dogs diagnosed with traumatic and nontraumatic hemoabdomen: 90 dogs (2009-2019)

OBJECTIVE

To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration.

DESIGN

Retrospective study between 2009 and 2019.

SETTING

University veterinary teaching hospital.

ANIMALS

Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH).

MEASUREMENTS AND MAIN RESULTS

Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded. A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1 g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44-3.40, P < 0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11-7.141, P = 0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04-1.12, P < 0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09-1.56, P = 0.003), and base excess (OR: 1.27, 95% CI: 1.1-1.49, P = 0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16-1.63, P < 0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scores (OR: 1.10, 95% CI: 1.04-1.17, P < 0.001) were associated with increased red blood cell transfusion administration.

CONCLUSIONS

Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1 g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLEfast scores.

Association of point-of-care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes

OBJECTIVE

To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes.

DESIGN

Retrospective study.

SETTING

University teaching hospital.

ANIMALS

Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventy-two venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO₂ (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO₂ (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium concentration (0.222 [0.071-0.700], P = 0.010), and chloride concentration (0.805 [0.694-0.933], P = 0.004) were associated with survival to hospital discharge.

CONCLUSIONS

Biochemical variables such as PvO₂ , SBE, and potassium concentration during CPR and pH, potassium, and chloride concentration in the postarrest period may help identify dogs and cats with lower odds for ROSC or survival to hospital discharge following CPR.

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.

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

OBJECTIVES

The purpose of this study was to prospectively evaluate the prognostic utility of the Animal Trauma Triage Score (ATTS) and Modified Glasgow Coma Scale (MGCS) in cats with high-rise syndrome.

METHODS

ATTS and MGCS were obtained upon arrival from 25 client-owned cats presented for high-rise syndrome. Cases were followed during hospitalisation and several variables, including outcome, were recorded.

RESULTS

The mortality rate in this cohort of cats with high-rise syndrome was 16%. Univariate statistical analysis showed that lactate (P = 0.022), creatinine (P = 0.01), body weight (P = 0.036) and ATTS (P = 0.02) were higher and MGCS (P = 0.011) lower among non-survivors. Multivariable statistical analysis showed that ATTS was the only factor significantly associated with mortality (odds ratio 2.41, 95% confidence interval [CI] 1.02-5.71; P = 0.046). A receiver operating characteristics curve showed that ATTS was an excellent predictor of mortality (area under the curve 0.917, 95% CI 0.8-1.0; P = 0.009). An ATTS cut-off of 6.0 had a 75% sensitivity and 90% specificity for non-survival and a cut-off of 10 had a 25% sensitivity and 100% specificity for non-survival.

CONCLUSIONS AND RELEVANCE

ATTS is predictive of severity and outcome in cats with high-rise syndrome and can help facilitate decision-making by owners and veterinarians.

High-rise syndrome in cats and dogs

OBJECTIVE

To review the current literature pertaining to the pathophysiology, diagnosis, and treatment of injuries sustained from high-rise syndrome in cats and dogs.

ETIOLOGY

High-rise syndrome is defined as a fall from a height of 2 or more stories that results in a constellation of injuries, including thoracic, abdominal, orthopedic, and orofacial trauma. Animals often fall after slipping from windowsills, engaging in mating behavior, or chasing prey. Cats suffer less severe injuries than dogs due to their "righting reflex" and smaller body mass. Affected animals are younger, and the frequency of falls is higher in warmer months.

DIAGNOSIS

Physical examination coupled with radiographs, ultrasound, and computed tomography can diagnose a myriad of injuries that include pneumothorax, pleural or abdominal effusion, orthopedic fractures, and orofacial injuries. Bloodwork may identify anemia, thrombocytopenia, or increases in hepatic, renal, or pancreatic values consistent with trauma to these organs. Serial venous or arterial blood gas can help determine the severity of respiratory compromise and influence resuscitative efforts. Traditional coagulation tests and thromboelastography can assess trauma-induced coagulopathy and guide transfusion therapy.

THERAPY

Animals presenting in shock require hemodynamic stabilization. Initial resuscitation may incorporate crystalloids, colloids, blood products, and analgesics. Thoracic injuries may require oxygen, thoracocentesis, chest tube placement, and mechanical ventilation. Fractures and wounds are decontaminated and splinted/bandaged, with definitive fixation pursued after stabilization. Abdominal injuries are managed medically unless there is severe ongoing bleeding, sepsis, or injury to the urinary tract.

PROGNOSIS

In feline high-rise syndrome, the prognosis is generally excellent following treatment, with survival exceeding 90%. Canine literature is sparse. The largest retrospective study reported a >90% survival to discharge and a greater need for surgical stabilization in this species. There are no prognostic factors identified that are associated with survival for either species.

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

OBJECTIVE

To retrospectively evaluate and stratify the differences in signalment, mechanisms, and severity of injury between toy and giant breed dogs.

DESIGN

Retrospective, observational cohort study.

SETTING

Multicenter, university veterinary teaching hospital, and private referral hospitals contributing to Veterinary Committee on Trauma (VetCOT) patient registry.

ANIMALS

Two thousand seven hundred and five (2589 toy and 116 giant breed) dogs presented for trauma with complete data entries recruited into the Veterinary Committee on Trauma registry from September 1, 2013 through December 31, 2017.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Injury etiology in toy breeds was predominantly blunt trauma (1532/2587 [59.2%]), commonly falling from a height or motor vehicle accident, whereas in giant breeds penetrating trauma was more common (71/116 [61.2%]). Eighty-seven percent (2231/2558) of toy breeds and 94.7% (108/114) giant breeds survived to discharge. When stratified by severity of injury (animal trauma triage [ATT] ≥ 5), mortality increased. Severely injured toy breeds had a 45.6% (200/438) survival rate, and severely injured giant breeds had a 62.5% (5/8) survival rate. Patient size did not impact survival in a logistic regression model; however, ATT score (odd ratio, 0.55; 95% CI, 0.52-0.58; P < 0.001), modified Glasgow Coma Scale (mGCS; odds ratio, 1.2; 95% CI, 1.11-1.32; P < 0.001), and base excess (odds ratio, 1.15; 95% CI, 1.09-1.22; P < 0.001) were predictive of nonsurvival. Surgical intervention was required in 743 of 2587 (29%) toy breeds and 65 of 116 (56%) giant breeds. Surgery was associated with an increased survival rate (odds ratio, 4.43; 95% CI, 2.45-8.83; P < 0.0001).

CONCLUSIONS

Evaluation of a large, multicenter dataset showed that ATT score along with base excess, plasma lactate, and mGCS were predictors of mortality independent of patient size. Severely injured dogs, as defined by an ATT score ≥ 5, were less likely to survive, and toy breed dogs had a higher mortality rate than giant breeds in the subcategory.

A positive association of larval therapy and hyperbaric oxygen therapy in veterinary wound care

The treatment of cutaneous wounds is part of the veterinary routine from initial scientific reports due to being regularly present condition. Currently, several types of treatments are available to accelerate the healing process. This report presents the case of a dog with multiple lesions in the thoracic limbs resulting from a car accident, who underwent larval therapy and hyperbaric oxygen therapy (HBOT). The animal was a 2-year-old female mixed breed dog presenting severe skin degloving, fracture in the left thoracic limb (LTL), with abrasion lesions and dislocation in the right thoracic limb (RTL). The animal underwent multiple modality therapies, such as HBOT sessions associated with larval therapy; even after the LTL presented gangrene, this treatment resulted in optimal viability of the non-necrotic tissue adjacent to the gangrene. Due to chronic pain unresponsive to drug control and the presence of a fracture at a location where a possible exoprosthesis was supposed to be fixed, the LTL ended up being amputated. There are several reports of the use of HBOT or larval therapy in traumatized limbs; however, the combination of both therapies has not been previously described in the veterinary literature. Thus, we demonstrate through this report that it was possible to quickly recover the animal with good wound resolution through tissue oxygenation and a healthy granulation bed, both provided by the therapeutic combination.

Volume Resuscitation in the Acutely Hemorrhaging Patient: Historic Use to Current Applications

Acute hemorrhage in small animals results from traumatic and non-traumatic causes. This review seeks to describe current understanding of the resuscitation of the acutely hemorrhaging small animal (dog and cat) veterinary patient through evaluation of pre-clinical canine models of hemorrhage and resuscitation, clinical research in dogs and cats, and selected extrapolation from human medicine. The physiologic dose and response to whole blood loss in the canine patient is repeatable both in anesthetized and awake animals and is primarily characterized clinically by increased heart rate, decreased systolic blood pressure, and increased shock index and biochemically by increased lactate and lower base excess. Previously, initial resuscitation in these patients included immediate volume support with crystalloid and/or colloid, regardless of total volume, with a target to replace lost vascular volume and bring blood pressure back to normal. Newer research now supports prioritizing hemorrhage control in conjunction with judicious crystalloid administration followed by early consideration for administration of platelets, plasma and red blood during the resuscitation phase. This approach minimizes blood loss, ameliorates coagulopathy, restores oxygen delivery and correct changes in the glycocalyx. There are many hurdles in the application of this approach in clinical veterinary medicine including the speed with which the bleeding source is controlled and the rapid availability of blood component therapy. Recommendations regarding the clinical approach to volume resuscitation in the acutely hemorrhaging veterinary patient are made based on the canine pre-clinical, veterinary clinical and human literature reviewed.

Combined effects of dexmedetomidine and vatinoxan infusions on minimum alveolar concentration and cardiopulmonary function in sevoflurane-anesthetized dogs

OBJECTIVE

To evaluate the effects of combined infusions of vatinoxan and dexmedetomidine on inhalant anesthetic requirement and cardiopulmonary function in dogs.

STUDY DESIGN

Prospective experimental study.

METHODS

A total of six Beagle dogs were anesthetized to determine sevoflurane minimum alveolar concentration (MAC) prior to and after an intravenous (IV) dose (loading, then continuous infusion) of dexmedetomidine (4.5 μg kg^-1 hour^-1) and after two IV doses of vatinoxan in sequence (90 and 180 μg kg^-1 hour^-1). Blood was collected for plasma dexmedetomidine and vatinoxan concentrations. During a separate anesthesia, cardiac output (CO) was measured under equivalent MAC conditions of sevoflurane and dexmedetomidine, and then with each added dose of vatinoxan. For each treatment, cardiovascular variables were measured with spontaneous and controlled ventilation. Repeated measures analyses were performed for each response variable; for all analyses, p < 0.05 was considered significant.

RESULTS

Dexmedetomidine reduced sevoflurane MAC by 67% (0.64 ± 0.1%), mean ± standard deviation in dogs. The addition of vatinoxan attenuated this to 57% (0.81 ± 0.1%) and 43% (1.1 ± 0.1%) with low and high doses, respectively, and caused a reduction in plasma dexmedetomidine concentrations. Heart rate and CO decreased while systemic vascular resistance increased with dexmedetomidine regardless of ventilation mode. The co-administration of vatinoxan dose-dependently modified these effects such that cardiovascular variables approached baseline.

CONCLUSIONS AND CLINICAL RELEVANCE

IV infusions of 90 and 180 μg kg^-1 hour^-1 of vatinoxan combined with 4.5 μg kg^-1 hour^-1 dexmedetomidine provide a meaningful reduction in sevoflurane requirement in dogs. Although sevoflurane MAC-sparing properties of dexmedetomidine in dogs are attenuated by vatinoxan, the cardiovascular function is improved. Doses of vatinoxan >180 μg kg^-1 hour^-1 might improve cardiovascular function further in combination with this dose of dexmedetomidine, but beneficial effects on anesthesia plane and recovery quality may be lost.

Evaluation of the rectal-interdigital temperature gradient as a diagnostic marker of shock in dogs

OBJECTIVE

To evaluate the difference in the rectal-interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock.

DESIGN

Prospective, single center, observational study conducted from 2014 to 2015.

SETTING

University veterinary teaching hospital.

ANIMALS

Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls).

MEASUREMENTS AND MAIN RESULTS

Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT (ρ = .353, P = 0.0013), tachycardia (ρ = .3485, P = 0.0015), decreased DBP (ρ = -0.6162, P = 0.0003), and shock index (ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604).

CONCLUSIONS

The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted.

Acid-Base, Electrolyte and Lactate Abnormalities as Well as Gastric Necrosis and Survival in Dogs With Gastric Dilation-Volvulus Syndrome. A Retrospective Study in 75 Dogs

Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO₂, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (-8.1 vs. -1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (-1.9 vs. -9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.

Retrospective evaluation of serum/plasma iron, red blood cell distribution width, and nucleated red blood cells in dogs with acute trauma (2009-2015): 129 cases

OBJECTIVE

To compare the prognostic value of admission hematologic parameters serum/plasma iron, red blood cell distribution width (RDW), and nucleated red blood cells (nRBCs) in dogs presenting with acute traumatic injury.

DESIGN

Retrospective observational study (2009-2015).

SETTING

University teaching hospital.

ANIMALS

One hundred and twenty-nine clinical dogs presenting within 24 hours of acute traumatic injury.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

One hundred and twenty-nine dogs met the inclusion criteria and 109 (84.5%) survived, while 20 (15.5%) died or were euthanized in hospital. Patients with blunt force trauma comprised 79.8% of the patient population; dogs with penetrating trauma comprised 20.2% of cases. Hypoferremia occurred in all nonsurvivors, and the median serum/plasma iron concentration was significantly lower in nonsurvivors than survivors (P = 0.028). Normal or increased serum/plasma iron had 100% specificity and 100% positive predictive value for survival. Red blood cell distribution width was not significantly different between groups (P = 0.417). The presence of nRBCs was significantly associated with nonsurvival (P = 0.030), although the absolute nRBC concentrations were not significantly different (P = 0.070). A multiple logistic regression model found age, type of injury, presence of nRBCs, and serum/plasma iron to be independent predictors of survival with an area under the receiver operator characteristic curve of 0.813.

CONCLUSIONS

The presence of nRBCs and low serum/plasma iron are associated with mortality in patients with acute trauma; however, red blood cell distribution width was not associated with survival. Absence of hypoferremia was highly associated with a favorable prognosis in this patient population. These parameters may warrant inclusion in trauma scoring systems.

Retrospective evaluation of factors influencing transfusion requirements and outcome in cats with pelvic injury (2009-2014): 122 cases

OBJECTIVE

To characterize a population of cats with pelvic trauma and evaluate factors influencing transfusion requirement and outcome.

DESIGN

Retrospective case series (2009-2014).

SETTING

University teaching hospital.

ANIMALS

One hundred twelve client-owned cats with pelvic trauma.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Twenty-one (18.8%) cats received a transfusion. Most cats required only 1 fresh whole blood transfusion (85.8%). Packed cell volume at admission was significantly lower in cats that required transfusion but was not associated with hospitalization time or survival to discharge. Increasing Animal Trauma Triage (ATT) score at admission was significantly associated with transfusion requirement (P = 0.0001) and nonsurvival to discharge (P = 0.03). Number of pelvic fractures was not associated with transfusion requirement but cats with sacroiliac luxations and pubic fractures were more likely to require a transfusion (P = 0.0015 and P = 0.0026, respectively). However, fracture type was not associated with survival to discharge. Most cats (86%) required a surgical procedure and half of transfusions were administered preoperatively. No surgical comorbidities were associated with transfusion requirement or survival. Transfusion requirement was associated with longer length of hospitalization but not survival to discharge.

CONCLUSIONS

Transfusion requirement in this population of cats with pelvic fractures was fairly high. Transfusion requirement was associated with lower packed cell volume, higher ATT score at admission, longer length of hospitalization, and certain types of pelvic fractures. Transfusion requirement was not associated with surgical comorbidities, surgical intervention, or survival to discharge. Lower ATT score at admission was associated with survival to discharge.

Performance evaluation and validation of the animal trauma triage score and modified Glasgow Coma Scale with suggested category adjustment in dogs: A VetCOT registry study

OBJECTIVE

To examine the animal trauma triage (ATT) and modified Glasgow Coma Scale (mGCS) scores as predictors of mortality outcome (death or euthanasia) in injured dogs.

DESIGN

Observational cohort study conducted from September 2013 to March 2015 with follow-up until death or hospital discharge.

SETTING

Nine veterinary hospitals including private referral and veterinary teaching hospitals.

ANIMALS

Consecutive sample of 3,599 dogs with complete data entries recruited into the Veterinary Committee on Trauma patient registry.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We compared the predictive power (area under receiver operating characteristic [AUROC]) and calibration of the ATT and mGCS scores to their components. Overall mortality risk was 7.3% (n = 264). Incidence of head trauma was 9.5% (n = 341). The ATT score showed a linear relationship with mortality risk. Discriminatory performance of the ATT score was excellent with AUROC = 0.92 (95% confidence interval [CI] 0.91 to 0.94) and pseudo R² = 0.42. Each ATT score increase of 1 point was associated with an increase in mortality odds of 2.07 (95% CI = 1.94-2.21, P < 0.001). The "eye/muscle/integument" category of the ATT showed poor discrimination (AUROC = 0.55). When this component together with the skeletal and cardiac components were omitted from calculation of the overall score, there was no loss in discriminatory capacity (AUROC = 0.92 vs 0.91, P = 0.09) compared with the full score. The mGCS showed good performance overall, but performance improved when restricted to head trauma patients (AUROC = 0.84, 95% CI = 0.79-0.90, n = 341 vs 0.82, 95% CI = 0.79-0.85, n = 3599). The motor component of the mGCS showed the best predictive performance (AUROC = 0.79 vs 0.66/0.69); however, the full score performed better than the motor component alone (P = 0.002). When assessment was restricted to patients with head injury (n = 341), the ATT score still performed better than the mGCS (AUROC = 0.90 vs 0.84, P = 0.04).

CONCLUSIONS

In external validation on a large, multicenter dataset, the ATT score showed excellent discrimination and calibration; however, a more parsimonious score calculated on only the perfusion, respiratory, and neurological categories showed equivalent performance.

Retrospective evaluation of 140 dogs involved in road traffic accidents

This study has retrospectively reviewed the medical records of 140 dogs sustaining road traffic accident (RTA), and has examined the population characteristics, medical history, injury type, physical examination, emergency laboratory tests and radiography findings, the animal trauma triage (ATT) score, the length of hospitalisation, the complications and the outcome. The survival rate was 83.2 per cent. Younger dogs sustained more frequently lung contusions and limb fractures, while larger dogs more frequently suffered limb fractures, and smaller dogs and older ones sustained more frequently pelvic fractures and sacroiliac luxation (P<0.05 for all). Dogs sustaining orthopaedic injuries required longer hospitalisation (P<0.001). The survival rates of non-ambulatory dogs (P<0.001) and those with neurological abnormalities (P<0.001), abnormal body temperature (P=0.001), hyperglycaemia (P=0.026) or hypoproteinaemia (P=0.04) at presentation were lower compared with those in which these were absent. The number of injured body systems was significantly (P<0.001) and positively associated with death. Dogs surviving RTA to presentation to the hospital have a good prognosis for survival to discharge. Older age, and high ATT score, abnormal body temperature, neurological deficits, hyperglycaemia and hypoproteinaemia at presentation, and occurrence of multiorgan trauma are negative prognostic indicators in such dogs.

Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals

Intravenous fluid therapy can alter plasma acid-base balance. The Stewart approach to acid-base balance is uniquely suited to identify and quantify the effects of the cationic and anionic constituents of crystalloid solutions on plasma pH. The plasma strong ion difference (SID) and weak acid concentrations are similar to those of the administered fluid, more so at higher administration rates and with larger volumes. A crystalloid's in vivo effects on plasma pH are described by 3 general rules: SID > [HCO3-] increases plasma pH (alkalosis); SID < [HCO3-] decreases plasma pH (alkalosis); and SID = [HCO3-] yields no change in plasma pH. The in vitro pH of commercially prepared crystalloid solutions has little to no effect on plasma pH because of their low titratable acidity. Appreciation of IV fluid composition and an understanding of basic physicochemical principles provide therapeutically valuable insights about how and why fluid therapy can produce and correct alterations of plasma acid-base equilibrium. The ideal balanced crystalloid should (1) contain species-specific concentrations of key electrolytes (Na+ , Cl- , K+ , Ca++ , Mg++ ), particularly Na+ and Cl- ; (2) maintain or normalize acid-base balance (provide an appropriate SID); and (3) be isosmotic and isotonic (not induce inappropriate fluid shifts) with normal plasma.

Retrospective evaluation of coyote attacks in dogs: 154 cases (1997-2012)

OBJECTIVE

To describe the clinical presentation and outcome of known attacks in client-owned dogs caused by the common coyote, Canis latrans.

DESIGN

Retrospective observational study.

SETTING

Private referral hospital.

ANIMALS

One hundred fifty-four client-owned dogs known to be attacked by coyotes.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Records from a private referral hospital from May 1997 through December 2012 were reviewed. Time of day and month/season of year, signalment, body temperature, heart rate, respiratory rate, body weight, location and severity of wounds inflicted, common injuries, length of hospitalization, necessity of surgical wound repair under anesthesia, antimicrobial use and mortality were recorded. Eighty-six percent of dogs presenting following coyote attack weighed <10 kg. Overall mortality rate was 15.6%. Dogs with bite wounds to the thorax had the highest mortality at 21.3%. Criteria for systemic inflammatory response syndrome (SIRS) based on admission vital signs were met in 58.8% of dogs and the presence of SIRS was significantly associated with mortality (P < 0.001). Common coyote-induced injuries included rib fracture (38/154; 24.6%), pulmonary contusion (30/154; 19.4%), tracheal tear (18/154; 11.6%), pneumothorax (16/154; 10.3%), abdominal wall hernia (9/154; 5.8%), and abdominal penetrating wounds (8/146; 5.5%). Dogs <10 kg were significantly more likely to incur wounds to multiple body parts or sustain abdominal penetrating wounds. The presence of rib fracture was significantly associated with mortality. Frequency of coyote attacks over the time of this study increased by 330%.

CONCLUSIONS

Coyote attacks on dogs are a problem in Southern California and are associated with substantial morbidity and mortality, especially in dogs with wounds to the thorax. Aggressive management involving surgical wound repair was associated with survival to discharge.

A systematic review of human and veterinary applications of noninvasive tissue oxygen monitoring

OBJECTIVE

To describe the methodology for and utilization of tissue oxygen monitoring by near infrared spectroscopy, and to review the current literature on the use of this monitoring modality in human and veterinary settings.

DATA SOURCES

Scientific reviews and original research found using the PubMed and CAB Abstract search engines with the following keywords: "tissue oxygen monitoring," "near-infrared tissue spectroscopy," and "tissue oxygen saturation (StO2 )."

HUMAN DATA SYNTHESIS

Tissue oxygen monitors have been evaluated in a wide variety of human clinical applications including trauma and triage, surgery, sepsis, and septic shock, and early goal-directed therapy. StO2 more rapidly identifies occult shock in human patients compared to traditional methods, which can lead to earlier intervention in these patients.

VETERINARY DATA SYNTHESIS

Veterinary studies involving tissue oxygen monitoring are limited, but the technology may have utility for identification of hemorrhagic shock earlier than changes in base excess, blood lactate concentration, or other traditional perfusion parameters.

CONCLUSION

Tissue oxygen monitoring is most commonly performed utilizing a noninvasive, portable monitor, which provides real-time, continuous, repeatable StO2 measurements. A decline in StO2 is an early indicator of shock in both human and veterinary patients. Low StO2 values in human patients are associated with increased morbidity, mortality, and length of hospitalization, as well as the development of multiple organ system dysfunction and surgical site infections.

Assessment of hemostatic changes in a model of acute hemorrhage in dogs

OBJECTIVE

To evaluate hemostatic changes following experimental acute hemorrhage in dogs using traditional coagulation tests (eg, platelet count, prothrombin time [PT], and activated partial thromboplastin time [aPTT]), kaolin-activated thromboelastography (TEG), and whole blood multiple electrode impedance platelet aggregometry.

DESIGN

Prospective study.

SETTING

Research laboratory.

ANIMALS

Five Beagles.

INTERVENTIONS

Dogs were anesthetized prior to obtaining blood samples for baseline PCV, total plasma protein (TPP), arterial blood-gas, platelet count, PT, aPTT, TEG, fibrinogen, and aggregometry. Blood was obtained at 4 additional time points, following 20% blood volume loss, 40% blood volume loss, 60 minutes of sustained hypotension, and after autologous blood transfusion. In addition, heart rate and direct arterial blood pressure were measured at each time point.

MEASUREMENTS AND MAIN RESULTS

Significant decreases were noted for PCV (P = 0.048), TPP (P < 0.0001), and arterial blood pressures (P < 0.0001) over time. Platelet count did not change significantly (P = 0.879), but platelet function was decreased following hemorrhage when arachidonic acid (P = 0.004) and ADP (P = 0.008) were used as agonists. The TEG variables R (P = 0.030), MA (P = 0.043), and G (P = 0.037) were significantly, albeit mildly, changed following hemorrhage. Significant prolongations in PT (P < 0.0001) and aPTT (P = 0.041), and decreases in fibrinogen concentration (P = 0.002) were also seen.

CONCLUSION

Platelet dysfunction occurred following hemorrhage in this model, despite a stable platelet count. Additionally, significant changes associated with hemorrhage were documented in aPTT, fibrinogen, and MA. Platelet function testing in dogs with naturally occurring hemorrhage warrants further investigation.