Mortality due to trauma in cats attending veterinary practices in central and south-east England

Surgical interventions and outcome in a population of canine trauma patients

OBJECTIVE

To determine signalment, injury type, trauma severity score, and outcome of canine trauma patients undergoing surgical (emergency room [ER] or operating room [OR]) and nonsurgical treatment in addition to time to surgery, specialty services involved, and cost in the OR surgery population.

DESIGN

Retrospective evaluation of medical record and hospital trauma registry data on canine trauma cases.

SETTING

University teaching hospital.

ANIMALS

One thousand six hundred and thirty dogs presenting for traumatic injury between May 2017 and July 2020.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Demographics and outcome were compared for canine trauma patients undergoing OR surgery (12.8%, 208/1630), ER surgery (39.1%, 637/1630), or no surgical intervention (48.2%, 785/1630). Among the 2 surgical groups, 98.9% (836/845) survived to discharge compared with 92.2% (724/785) of the nonsurgical group (P < 0.0001). The OR surgical group had significantly higher median Animal Trauma Triage scores (2 vs 1, P < 0.0001) and median days in hospital (2 vs < 1, P < 0.0001) compared with the other groups. For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (45.2%, 94/208) and general surgery (26.9%, 56/208). Neurology and general surgery cases required the longest median length of stay in hospital, and ophthalmology and dentistry cases required the shortest. The median cost of visit was highest in neurology ($10,032) and lowest in ophthalmology ($2305) and dentistry ($2404).

CONCLUSIONS

Surgical intervention in canine trauma patients appears to be associated with higher survival rates, and among the surgery groups, mortality was highest in the ER and general surgery groups. OR surgical intervention, in particular general surgery and neurology, was associated with increased length of hospitalization, increased cost, and higher Animal Trauma Triage scores.

Morbidity of insured Swedish cats between 2011 and 2016: Comparing disease risk in domestic crosses and purebreds

BACKGROUND

Sources of population-based cat health information are scarce. The objective of this study was to determine disease frequency in cats using pet insurance data to inform health promotion efforts.

METHODS

A descriptive analysis of cats insured with Agria Pet Insurance in Sweden (2011-2016) was performed. Incidence rates of broad disease categories were calculated based on veterinary care events and an exact denominator consisting of cat-years-at-risk. Rate ratios were calculated, comparing domestic crosses to all purebreds and specific purebreds to all other purebreds combined.

RESULTS

The study included over 1.6 million cat-years-at-risk (78.5% were domestic crosses), 18 breeds and 24 disease categories. The most common disease categories causing morbidity in purebreds were digestive, whole body, injury, urinary lower, skin and female reproduction. Purebreds had the highest relative risk (compared to domestics crosses) in the female reproduction, heart, operation complication, respiratory lower and immunological disease categories.

LIMITATIONS

There are typical limitations of secondary data, but they do not negate the overall value of such a large dataset.

CONCLUSION

This study demonstrates how pet insurance data can be used to find breed-specific differences in the incidence of various disease categories in cats. This may be of importance for breeders, cat owners, veterinarians and researchers.

Surgical interventions and outcome in a population of feline trauma patients

OBJECTIVE

To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population.

DESIGN

Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases.

SETTING

University teaching hospital.

ANIMALS

Two hundred and fifty-one cats presenting for traumatic injury between May 2017 and July 2020.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P < 0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P < 0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P = 0.0553). No difference in modified Glasgow Coma Scale score was found between any groups.

CONCLUSIONS

Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.

Population Dynamics of Community Cats Living in a Tourist Area of Onomichi City, Japan, before and after the Trap-Test-Vaccinate-Alter-Return-Monitor Event

The community cat program (CCP) was recommended by the Ministry of the Environment to reduce cats in local animal shelters and improve stray cat welfare in Japan. It is a non-lethal control measure with stray cats cared for as free-roaming cats for their lifetime in the community, while Trap-Neuter-Return (TNR) or Trap-Test-Vaccinate-Alter-Return-Monitor (TTVARM) activities are carried out. In the CCP, community cat colonies are hypothesized to be closed and static populations. However, it remains unknown whether the cats stay in the colonies, without migration of non-neutered cats following TNR/TTVARM events. We examined the population dynamics of cats before and after a TTVARM event using route censuses (107 days), fixed-point observations, and GPS-tracking in a tourist area in Onomichi. Eleven out of the 30 cats remained in the CCP areas, whereas 13 non-neutered cats immigrated into the CCP areas, within a year, suggesting the CCP program has limited efficacy. Besides, the program cannot support the lifetime management of the cats due rapid turnover of cats. Our results reject the CCP hypothesis, so that the program neither restricts cat breeding nor enhances cat welfare.

Commonly diagnosed disorders in domestic cats in the UK and their associations with sex and age

OBJECTIVES

The objectives of this study were to generate a robust evidence base on the prevalence of common disorders in cats and develop a deeper understanding of disorder associations with sex and age that could offer important opportunities for targeted veterinary care to improve feline health and welfare.

METHODS

A random sample of 18,249 cats was obtained from 1,255,130 cats under primary care during 2019 within VetCompass, an epidemiological research programme based on anonymised primary care veterinary clinical records. All disorders recorded during 2019 were extracted and reported, and associations with sex and age were examined.

RESULTS

The most prevalent disorders were periodontal disease (n = 2780 [15.2%], 95% confidence interval [CI] 14.72-15.76), obesity (n = 2114 [11.6%], 95% CI 11.12-12.06) and dental disease (n = 1502 [8.2%], 95% CI 7.84-8.64). Compared with male cats, females had an increased prevalence of poor quality of life, postoperative complications and hyperthyroidism, among others. Male cats had a higher prevalence of periodontal disease, road traffic accident (RTA) and obesity. Younger cats (<8 years) had an increased prevalence of cat bite abscess, flea infestation and RTA, while older cats (⩾8 years) had increased prevalence of lameness, cystitis and dental disease, among others.

CONCLUSIONS AND RELEVANCE

These findings suggest that the veterinary profession needs to engage more effectively in informing owners on common preventable disorders (ie, obesity and dental disease). This new information can contribute to more targeted health surveillance and more effective veterinary interventions to promote improved health and welfare in pet cats. Large-scale collection and analysis of anonymised veterinary clinical records offer an important clinical resource for research.

Clinical parameters at time of admission as prognostic indicators in cats presented for trauma to an emergency centre in New Zealand: a retrospective analysis

OBJECTIVES

The aims of this study were to describe the clinical features of cats presented for trauma in a first-opinion and referral teaching hospital in New Zealand, and to determine the relationship between those features and outcome.

METHODS

The electronic medical records of cats presented for trauma to the Massey University Pet Emergency Centre between September 2013 and January 2019 were examined, from which the signalment, clinical parameters and patient outcomes were extracted. Cases were assigned an Animal Trauma Triage (ATT) score and Modified Glasgow Coma Scale (MGCS) score. Variables were selected for inclusion in a logistic regression model to predict survival, and backward elimination was used to find the minimal significant model.

RESULTS

In total, 530 cats met the inclusion criteria. The cause of injury was not known in the majority of cases (38.0%). The most common location of injury was the hindlimbs/pelvis/tail (n = 247; 41%), and skin lacerations/abrasions were the most common specific injury. Multivariate analysis revealed altered mentation (odds ratio [OR] 0.31, P = 0.029), hypothermia (rectal temperature <37.8°C [<100.04°F]; OR 0.45, P = 0.015) and an ATT score ⩾5 (OR 0.13, P <0.001) to be statistically significantly associated with mortality.

CONCLUSIONS AND RELEVANCE

Altered mentation and hypothermia are easily measurable perfusion parameter abnormalities associated with mortality in cats presenting with trauma. The ATT score appears to be an accurate prognostic indicator in cats presenting with trauma in New Zealand. These results highlight the importance of incorporating a hands-on triage examination in each cat that presents as an emergency after trauma.

Intensive Adoption as a Management Strategy for Unowned, Urban Cats: A Case Study of 25 Years of Trap-Assess-Resolve (TAR) in Auckland, New Zealand

Globally, unowned urban cats are a major concern because they may suffer from poor welfare and cause problems, including public health risks, nuisances, and urban wildlife predation. While management options are often presented as a choice between culling or trap−neuter−return (TNR), for 25 years, the Lonely Miaow (Inc.) charity in Auckland, New Zealand (hereafter LM), has used a third strategy—intensive adoption or trap−assess−resolve (TAR). As of 2019, of 14,611 unowned cats trapped, 64.2% were adopted, 22.2% were euthanized if unsocialised or in grave ill-health, 5.7% were neutered and returned to the site, and 7.9% had other outcomes, such as being transferred to other shelters. Adoption rates increased over this time, exceeding 80.0% in 2018 and 2019. The cost of processing each cat from capture to adoption rose from NZD 58 in 1999 to NZD 234 by 2017. Approximately 80% of colonies (sites where cats were trapped) were around residential areas. Approximately 22% of cats required veterinary treatment after capture; common ailments included respiratory infections, ringworm, dental problems, and trauma. Consistently, 52% of cats were young kittens (<10 weeks old), c. 80% of cats were <1 year old, and only c. 2% were estimated to be >5 years old. TAR avoids euthanasia where possible. Its effectiveness would be enhanced by fewer abandonments of owned cats and kittens, fitting within integrated strategies for the control of unowned cats involving community education. Cat adoptions improve the welfare of cats and, with appropriate husbandry, should alleviate concerns about nuisances, public health, and attacks on wildlife or the cats themselves, essentially benefitting the community and the cats. This case study is relevant to other cities around the world that are seeking to manage unowned cats.

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.

Indoors or Outdoors? An International Exploration of Owner Demographics and Decision Making Associated with Lifestyle of Pet Cats

Simple Summary

Owners may consider many factors when deciding whether to provide an indoor-only or indoor-outdoor lifestyle for their cats. These include safety, mental and physical health, exposure to parasites or disease, and depredation of wildlife. This international study used a series of online surveys to explore the factors cat owners consider when deciding what lifestyle to provide for their cat, alongside investigating if owner and cat features are associated with greater odds of cats having indoor-only or indoor-outdoor lifestyles. Ten variables were found to be significant predictors of lifestyle. Owner features predicting a greater likelihood of cats being kept as indoor-only were being 26–35 years old, having multiple cats, living in city centres or urban areas, and living in the United States, Canada, Australia, or New Zealand. For cats, these features included being junior, having health issues, being pedigree, or having unknown pedigree status. Owner features predicting a greater likelihood of cats being indoor-outdoor were owners being 46–55+ years old or 56+ years old and having children (17 years old or under) living at home. For cats, features included being male and being mature or senior. Road traffic accidents were the major concern for owners of indoor-only cats in all regions surveyed. Owners who provided outdoor access predominantly indicated they did so for the mental wellbeing of their cat. These findings are important in understanding the considerations owners give to their cat’s lifestyle and identifying management trends and cat populations potentially at risk of compromised welfare due to unsuitable lifestyles.

Abstract

Outdoor access for owned domestic cats (Felis catus) is a divisive issue. Cat safety, mental and physical wellbeing, infectious diseases, and wildlife depredation are cited as factors influencing owners; however, the degree of consideration each factor receives has not been quantified. This study (i) analysed which demographic variables are associated with greater odds of cats having indoor or outdoor lifestyles, (ii) identified which factors owners consider when making a choice on lifestyle and any regional variations, and (iii) identified if owners consider the different lifestyle options available and recognise their associated benefits. A series of online surveys were used for data collection. Binary logistic regression models were used to generate odds ratios assessing if demographic variables were significantly associated with cat lifestyle. Quantitative analysis of factors considered when deciding on cat lifestyle was accompanied by a thematic analysis of rich-text open-ended responses, providing nuanced insight into the rationale and elucidating additional factors considered. Of the demographic variables tested, 10/12 were significantly associated with lifestyle. Variables with higher odds of indoor-only lifestyles were owners being 26–35 years old, multi-cat households, junior cats, pedigree cats or unknown pedigree status, cats with health issues, living in city centres or urban areas, or living in the United States, Canada, Australia, or New Zealand. Variables with higher odds of indoor-outdoor lifestyles were owners being 46–55 years old or 56+ years old, households with residents 17 years old or under, male cats, and cats being mature or senior. Road traffic concerns were the most cited reason for keeping indoor-only cats across all global regions. The second-most cited reason varied regionally. For Europe, it was protection from people. For the USA and Canada, the reason was protection from wildlife, and for Australia and New Zealand, to prevent hunting. Indoor-outdoor cat owners cited most frequently the benefits to their cat’s mental health. Over two-thirds of owners did not consider the alternative lifestyle for their cat. These data give insight into the priorities of cat owners with regards to feline wellbeing, feline safety, and wildlife depredation, helpful for individuals or organisations working with human behaviour change. They provide evidence that the numbers of indoor-only cats are likely to rise with increasing urbanisation. Finally, the data identify cat populations who may be at risk of compromised welfare due to unsuitable, or under-researched, lifestyles.

Introducing a Controlled Outdoor Environment Impacts Positively in Cat Welfare and Owner Concerns: The Use of a New Feline Welfare Assessment Tool

There is much debate over the pros and cons of allowing cats to roam freely as opposed to keeping them confined indoors. We surveyed owners who implemented a commercial physical containment system to the outdoors to evaluate their characteristics and the apparent impact of this system on cat welfare and owner perceptions. As part of the latter aim, we also developed a new feline welfare assessment tool based on the mathematical relationship between different measures. The survey was circulated to customers over the preceding 2 years of ProtectaPet® between May and June 2019 and gathered 446 responses. Univariate analyses compared changes following installation on factors such as the amount of time the cat spent outside, other cats entering the owner's garden and owners' concerns about their cat outside. Principal component analysis was used to reduce 21 potential indicators of feline welfare into fewer variables. This resulted in 4 subscales, 2 relating to positive welfare and 2 relating to negative welfare. The effects of installation of the containment system and significant predictors of these four welfare subscales were assessed. The majority of respondents lived in an urban environment with a relatively small garden, had multiple cats and a history of feline trauma associated with a road traffic accident. As expected, the time spent outside significantly increased, while the frequency of other cats entering the garden and owner concern about leaving their cats outside significantly decreased. The 4 welfare subscales grouped into positivity, maintenance behaviors, health issues and fearfulness; installation of the system was associated with significant improvements across all of these. Time spent outside after installation had a significant effect on positivity and, to a lesser extent, maintenance behaviors. Overall, installation was associated with positive changes in both owner and cat quality of life, which seem to be particularly associated with an increased sense of security. This suggests that housing cats within a controlled outside environment with physical barriers can provide a practical solution for many of the problems associated with cats being allowed out.

Feline skull injuries: Treatment goals and recommended approaches

PRACTICAL RELEVANCE

Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice.

CLINICAL APPROACH

Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient's ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries.

TREATMENT GOALS AND TECHNIQUES

A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal's oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain.

AIM

This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

Prognostic Significance of Organ Dysfunction in Cats With Polytrauma

Polytrauma is a common emergency condition in small animals and is frequently associated with higher morbidity and mortality rates compared to minor trauma. Multiple Organ Dysfunction Syndrome (MODS) is a major complication of extensive traumatic injury, carrying a high risk of death despite intensive care treatment. Little is known about the prevalence and the prognostic impact of MODS in feline polytrauma. The current study aimed to prospectively evaluate the occurrence and the prognostic significance of organ dysfunction at admission in a population of polytraumatized cats. Cats with polytrauma requiring intensive care unit hospitalization were included and categorized according to outcome (survivors/non-survivors). Clinical and clinicopathological data, including scores of disease severity [Animal Trauma Triage Score (ATTS), APPLE_fast, and APPLE_full], selected organ dysfunction and presence of MODS were evaluated upon admission, and analyzed with respect to mortality. Non-parametric statistics was performed and P < 0.05 was considered significant. Thirty-eight cats met the inclusion criteria: 8/38 (21%) had penetrating trauma, while 30/38 (79%) had blunt trauma. The overall in-hospital mortality was 37% (14/38). Cats with evidence of MODS upon admission had significantly higher frequency of death compared to cats without MODS (9/14 vs. 2/24 P = 0.0004). Hemostatic dysfunction, respiratory dysfunction, and MODS upon admission were significantly associated with mortality in the univariate logistic regression analysis (P = 0.005, P = 0.001, P = 0.001, respectively). The values of APPLE_fast, APPLE_full, and ATTS were independently associated with a higher risk of death and positively correlated with the number of dysfunctional organs (P = 0.025, P = 0.004, P = 0.003, r = 0.57, P = 0.0002; r = 0.59, P = 0.0001; r = 0.55, P = 0.0003, respectively). Multiple Organ Dysfunction Syndrome is a common complication of feline polytrauma and its development is associated with increased disease severity and worse outcomes. The presence of hemostatic dysfunction and respiratory dysfunction upon admission is associated with a higher risk of death. The ATTS and the APPLE scores are useful prognostic tools for the assessment of cats with polytrauma.

A Case of Letting the Cat out of The Bag-Why Trap-Neuter-Return Is Not an Ethical Solution for Stray Cat (Felis catus) Management

Trap-Neuter-Return (TNR) programs, in which stray cats are captured, neutered and returned to the environment are advocated as a humane, ethical alternative to euthanasia. We review the TNR literature in light of current debate over whether or not there should be further TNR trials in Australia. We revisit the problems arising from stray cats living in association with human habitation and estimate how many stray cats would have to be processed through a scientifically-guided TNR program to avoid high euthanasia rates. We also identify 10 ethical and welfare challenges that have to be addressed: we consider the quality of life for stray cats, where they would live, whether the TNR process itself is stressful, whether TNR cats are vulnerable to injury, parasites and disease, can be medically treated, stray cats' body condition and diet, and their impacts on people, pet cats, and urban wildlife, especially endemic fauna. We conclude that TNR is unsuitable for Australia in almost all situations because it is unlikely to resolve problems caused by stray cats or meet ethical and welfare challenges. Targeted adoption, early-age desexing, community education initiatives and responsible pet ownership have greater promise to minimize euthanasia, reduce numbers rapidly, and address the identified issues.

Epidemiology of road traffic accidents in cats attending emergency-care practices in the UK

OBJECTIVES

To estimate the incidence proportion of road traffic accidents in cats attending emergency out-of-hours clinics in the UK, identify major risk factors for road traffic accident occurrence and for survival to discharge.

MATERIALS AND METHODS

A retrospective study of a cohort of 33,053 cats in the VetCompass database attending emergency-care practice between January 1, 2012 and February 15, 2014. Incidence proportion was calculated and logistic regression was used to identify risk factors for road traffic accident and survival to discharge following road traffic accident.

RESULTS

Incidence proportion was estimated at 4∙2% (95% confidence interval: 4∙0 to 4∙4%). Cats aged 6 months to 2 years were at increased odds of road traffic accident, as were male cats and crossbred cats. Odds of road traffic accident were highest in the autumn. Spinal injury, abdominal injury and increasing count of injuries were associated with increased odds of death.

CLINICAL SIGNIFICANCE

Road traffic accident is a frequent presentation in emergency-care practice. Identification of risk factors for death within the first 24 hours following a road traffic accident can aid veterinarian and owner decision-making for treatment of cats involved in a road traffic accident.