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

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.

Prospective evaluation of platelet function and fibrinolysis in 20 dogs with trauma

OBJECTIVES

To determine platelet function and assess fibrinolysis in dogs following trauma using multiple electrical impedance aggregometry and a modified thromboelastographic (TEG) technique. To determine if the severity of trauma, as assessed by the Animal Trauma Triage (ATT) score and clinicopathological markers of shock, is associated with a greater degree of platelet dysfunction and fibrinolysis.

SETTING

University teaching hospital.

ANIMALS

Twenty client-owned dogs with trauma (occurring <24 h prior to admission and blood sampling) and ATT score of >4 were prospectively recruited. A control group of 10 healthy dogs was included.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Platelet function was measured using multiple electrode platelet aggregometry (MEPA) utilizing arachidonic acid, ADP, and collagen agonists. Fibrinolysis was assessed in citrated whole blood with the addition of tissue plasminogen activator (tPA; 50 U/mL) using kaolin-activated TEG. Conventional statistical analysis was performed to compare coagulation parameters between the groups and assess linear correlations. Median (interquartile range) ATT score was 5 (5-7), and 65% (n = 13) of dogs suffered polytrauma. Mean (± SD) time from trauma to blood sampling was 9 hours (± 6). Median (interquartile range) shock index and plasma lactate concentration were 1.1 (0.7-2.0, n = 16) and 2.9 mmol/L (0.9-16.0, n = 18), respectively. Four dogs did not survive to discharge (20%). There were no differences between the trauma and control group coagulation variables. A moderate negative correlation between ATT score and area under the curve for ADP was found (P = 0.043, r2  = -0.496).

CONCLUSIONS

Preliminary evaluation of platelet function measured by MEPA, and fibrinolysis measured by tPA-modified TEG, is not significantly different in this population of dogs with traumatic injury compared to healthy dogs.

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.

Ballistic trauma to the axial skeleton in 13 animals

OBJECTIVE

To describe the clinical presentation and outcome of small animals that sustained ballistic trauma to the axial skeleton.

DESIGN

Retrospective, multicenter observational study.

SETTING

Two university teaching hospitals.

ANIMALS

Twelve client-owned dogs and 1 client-owned cat sustaining ballistic trauma to the axial skeleton.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Thirteen animals sustaining ballistic trauma to the axial skeleton with complete medical records were included in this study. Twelve of 13 animals survived to discharge; 1 animal was euthanized shortly after presentation. Two animals had ophthalmic abnormalities, 9 animals had neurologic lesions, and 2 animals had no significant ophthalmic or neurologic deficits. Neurolocalization of injury included peripheral vestibular (n = 1), multifocal brain (n = 1), brainstem (n = 1), C1-C5 (n = 1), C6-T2 (n = 1), T3-L3 (n = 3), and L4-S3 (n = 1). Seven dogs underwent surgical intervention: 5 neurosurgical, 1 enucleation, and 1 laparotomy. Median hospitalization time was 6 days with a range from 1 to 31 days.

CONCLUSIONS

Overall prognosis and outcome are variable and dependent on specific injury location and degree of injury.

Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative small animal CPR registry report 2016-2021

OBJECTIVE

To introduce the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR registry and report cardiopulmonary arrest (CPA) and CPR event data collected to date.

DESIGN

International, multi-institutional veterinary CPR registry data report.

SETTING

Veterinary private practice and university teaching hospitals.

ANIMALS

Data from 514 dogs and 195 cats undergoing CPR entered in the RECOVER CPR registry between February 2016 and November 2021.

INTERVENTIONS

The RECOVER CPR registry is an online medical database created for standardized collection of hospital, animal, arrest, and outcome information on dogs and cats undergoing CPR. Data were collected according to the veterinary Utstein-style guidelines for standardized reporting of in-hospital CPR in dogs and cats. Case records were downloaded, duplicate and incomplete cases were removed, and summary descriptive data were reported.

MEASUREMENTS AND MAIN RESULTS

Sixteen hospitals in the United States, Europe, and Australia contributed data on 709 CPR events to the registry. One hundred and forty-two (28%) dogs and 58 (30%) cats attained return of spontaneous circulation (ROSC), 62 (12%) dogs and 25 (13%) cats had ROSC >20 minutes, and 14 (3%) dogs and 4 (2%) cats survived to hospital discharge. The reason for CPR discontinuation was reported as owner choice in 321 cases (63%). The most common suspected causes for CPA were respiratory failure (n = 142, 20%), heart failure (n = 86, 12%), and hemorrhage (n = 76, 11%).

CONCLUSION

The RECOVER CPR registry contains the first multicenter data set on small animal CPR. It confirms poor outcomes associated with CPA, emphasizing the need for large-sized studies to gain adequate information on characteristics associated with favorable outcomes.

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

OBJECTIVE

To evaluate outcome (survival to discharge) among trauma types (blunt, penetrating, both) in dogs. The secondary objective was to evaluate if other trauma registry parameters differ between trauma types and influence survival.

DESIGN

Retrospective evaluation of veterinary trauma registry data.

SETTING

Veterinary Committee on Trauma (VetCOT) identified Veterinary Trauma Centers (VTCs).

ANIMALS

A total of 20,289 canine trauma patients with data entered in the VetCOT trauma registry from April 1, 2017 to December 31, 2019 INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS

Data were obtained from the VetCOT database and included patient demographics, trauma type (blunt, penetrating, both), Animal Trauma Triage (ATT) score, modified Glasgow Coma Scale (mGCS), abdominal fluid score (AFS), loss of glide sign on thoracic focused assessment with sonography for trauma (TFAST), pleural effusion on TFAST, surgical procedure performed and in what location (emergency room vs operating room), and outcome. Data from 20,289 dogs were collected over a 30-month period. The most common type of trauma was penetrating (10,816, 53.3%), followed by blunt (8360, 41.2%) and then combined blunt and penetrating trauma (1113, 5.5%). Dogs suffering only penetrating trauma had a 96.5% survival rate, blunt trauma had an 89.5% survival rate, and combined trauma had an 86.3% survival rate. Dogs suffering from both types of trauma had higher ATT scores, lower mGCS scores, and were more likely to be admitted to the ICU. Trauma type, mGCS, and ATT score were found to be associated with survival.

CONCLUSIONS

The present study highlights that dogs suffering from a combination of blunt and penetrating trauma are more likely to suffer moderate to severe injuries, have lower survival rates, and are more likely to be admitted to the ICU compared to dogs suffering from only blunt or penetrating trauma. Trauma type, mGCS, and ATT scores were found to be associated with survival in all groups.

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

OBJECTIVE

To evaluate admission Animal Trauma Triage (ATT) score, shock index (SI), and markers of perfusion, including base excess (BE), plasma lactate, and lactate clearance in dogs with blunt trauma.

DESIGN

Prospective observational clinical study from 2013 to 2015.

SETTING

Private veterinary referral and emergency center.

ANIMALS

Forty-four client-owned dogs hospitalized following blunt trauma.

INTERVENTION

Within 1 hour of presentation and prior to fluid administration an initial hematocrit, total plasma protein, blood glucose, plasma lactate, blood gas, and electrolytes were obtained for analysis. Plasma lactate concentrations were also measured 4 and 8 hours following initial measurement, and a 4-hour lactate clearance was calculated if patients had an increased admission plasma lactate. ATT score and SI were calculated for each patient based on admission data. Outcome was defined as survival to hospital discharge.

MEASUREMENTS AND MAIN RESULTS

Twenty-nine dogs survived, 14 were euthanized, and 1 died. Nonsurviving dogs had a lower mean pH (7.28 ± 0.03 vs 7.36 ± 0.01, P = 0.006), lower median HCO₃ (15.7 vs 18.8 mmol/L, P = 0.004), lower median admission BE (-11.0 vs -7.0 mmol/L, P = 0.004), and higher median admission lactate (3.1 vs 2.4 mmol/L, P = 0.036) than those who survived. Median ATT was significantly higher in nonsurvivors (5 vsF 2, P < 0.001). The SI was not significantly different between survivors and nonsurvivors (P = 0.41). There was no difference in median 4-hour lactate (P = 0.34), median 8-hour lactate (P = 0.19), or 4-hour lactate clearance (P = 0.83) in survivors compared to nonsurvivors. No other statistically significant differences were noted between groups.

CONCLUSION

Dogs hospitalized following blunt trauma with a lower admission pH, HCO₃ , and BE and a higher admission plasma lactate were less likely to survive to hospital discharge. Median ATT score was also significantly higher in nonsurvivors. Although lactate clearance was not predictive of survival, the sample size was small, and additional studies with a larger study population are warranted.

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

OBJECTIVES

To identify demographic information, epidemiological factors, and clinical abnormalities that differentiate cats with severe trauma, defined as an Animal Trauma Triage Score (ATTS) ≥3 from those with mild injury (ATTS 0-2).

DESIGN

Multicenter observational study utilizing data from the American College of Veterinary Emergency and Critical Care (ACVECC) Veterinary Committee on Trauma (VetCOT) registry.

SETTING

ACVECC VetCOT Veterinary Trauma Centers.

ANIMALS

A total of 3859 cats with trauma entered into the ACVECC VetCOT registry between April 1, 2017 and December 31, 2019.

INTERVENTIONS

None MEASUREMENTS AND MAIN RESULTS: Cats were categorized by ATTS 0-2 (mild, 65.1%) and ≥3 (severe, 34.9%). There was no age difference between categories. Male animals, particularly intact animals, were overrepresented. Blunt trauma was more common than penetrating, with blunt trauma and a combination of blunt and penetrating trauma being more common in the severe trauma group. While 96.6% of cats with ATTS 0-2 survived to discharge, only 58.5% with ATTS ≥3 survived. Only 46.8% of cats with severe trauma had a point-of-care ultrasound performed, of which 8.9% had free abdominal fluid noted. Hospitalization and surgical procedures were more common in the severe trauma group. Transfusions occurred more frequently in the severe trauma group but only in 4.1% of these cats. Other than ionized calcium, all recorded clinicopathological data (plasma lactate, base excess, PCV, total plasma protein, blood glucose) differed between groups.

CONCLUSION

Feline trauma patients with an ATTS ≥3 commonly present to Veterinary Trauma Centers and have decreased survival to discharge compared to patients with ATTS 0-2. Differences exist between these groups, including an increased frequency of blunt force trauma (particularly vehicular trauma), head and spinal trauma, and certain clinicopathological changes in the ATTS ≥3 population. Relatively low incidences of point-of-care ultrasound evaluation and transfusions merit further investigation.

Effect of COVID-19 Lockdown on Small Animal Trauma Patterns in Australia: A Multicentre Study

Objective

To determine whether patterns of trauma changed following the start of local lockdowns due to COVID-19.

Design

Multi-institutional retrospective study assessing patients presenting within 2 years prior to local lockdown due to COVID-19 and 1 year following lockdown inclusive.

Setting

Two university teaching hospitals and one private referral center in Australia.

Animals

Dogs and cats with a presenting complaint of known or suspected trauma.

Interventions

Patient signalment, date of presentation, trauma type, treatment interventions and patient outcome (survival to discharge, cardiopulmonary arrest, or euthanasia) were recorded in a web-based data capture system (REDCap).

Measurements and Main Results

Three thousand one hundred eighty-nine patients (682 cats and 2,507 dogs) were included in the study. Overall trauma prevalence was 2.9% with pre-lockdown prevalence of 2.8% and post-lockdown prevalence of 3.1% (p < 0.001). Cats had higher rates of blunt trauma while penetrating trauma was more prevalent in dogs (p < 0.001). Juvenile patients were also more likely to have blunt trauma when compared to adult patients (p < 0.001). Patient age and sex characteristics did not differ when comparing the 2 time periods. Compared to pre-lockdown, blunt and penetrating trauma patterns changed post-lockdown in dogs and cats (p < 0.001 for both). Interventions were performed more frequently (p = 0.039) in the post-lockdown with surgical procedures having a significant increase (p = 0.015). Survival rates increased post-lockdown for both species (p < 0.001) with financially driven euthanasia being less common than in pre-lockdown for dogs (p = 0.02).

Conclusions

Trauma patterns changed for cats and dogs in the post-lockdown period. Compared to pre-lockdown, trauma prevalence was higher with a decrease in mortality rate. No increase in juvenile patients was identified post-lockdown. A decrease in financially driven euthanasia and an increase in interventions suggest no negative financial effect from COVID-19 lockdown on trauma patient care in Australia.

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.

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.

Distribution of mortality patterns in cats with naturally occurring trauma: A Veterinary Committee on Trauma registry study

A greater understanding of the prognostic variables that affect the timing of death for cats with trauma may help clinicians select treatments and monitoring plans. This study investigated the mortality rate and its distribution pattern in a large population of cats to identify variables associated with the timing of trauma-related deaths. Clinical data was retrieved from the Veterinary Committee on Trauma database to determine mortality rates and timing of deaths, defined as early death (ED; <1 day post-presentation) or delayed death (DD; ≥1 day post-presentation). Multivariable logistic regression analyses were performed to identify characteristics and interventions that best predicted timing of death. Overall mortality rate for 6703 feline trauma patients with complete records was 17.2%, with 7.6% due to natural death and 92.3% due to euthanasia. Among the subset of 543 cats with trauma that died after presentation or required euthanasia due to a grave prognosis (representing an 8.1% mortality rate), EDs were more common (71.7%) than DD and the cause of death was not significantly associated with the timing of death. Clinical pathology parameters were unable to identify animals more likely to die or to require euthanasia due to a poor prognosis during hospitalisation. Factors that were significantly different for cats with ED vs. DD included the median cumulative results for the Modified Glasgow Coma Scale (MGCS) score and the Animal Trauma Triage (ATT) score, the presence of spinal trauma, administration of blood products and undertaking surgical procedures. An increased likelihood of DD rather than ED was associated with the administration of blood products (odds ratio [OR], 3.959; P = 0.019) vs. not, performing a surgical procedure (OR, 6.055; P < 0.001) vs. not, and a cumulative MGCS of 15-17 or 18 (OR, 1.947 and 3.115; P = 0.031 and P = 0.01, respectively) vs. a cumulative MGCS ≤ 11.

Intratumoral Delivery of STING Agonist Results in Clinical Responses in Canine Glioblastoma

PURPOSE

Activation of STING (stimulator of interferon genes) can trigger a robust, innate antitumor immune response in immunologically "cold" tumors such as glioblastoma.

PATIENTS AND METHODS

A small-molecule STING agonist, IACS-8779, was stereotactically administered using intraoperative navigation intratumorally in dogs with spontaneously arising glioblastoma. The phase I trial used an escalating dose design, ascending through four dose levels (5-20 μg). Treatment was repeated every 4-6 weeks for a minimum of two cycles. Radiographic response to treatment was determined by response assessment in neuro-oncology (RANO) criteria applied to isovoxel postcontrast T1-weighted MR images obtained on a single 3T magnet.

RESULTS

Six dogs were enrolled and completed ≥1 cycle of treatment. One dog was determined to have an abscess and was removed from further analysis. One procedure-related fatality was observed. Radiographic responses were dose dependent after the first cycle. The first subject had progressive disease, whereas there was 25% volumetric reduction in one subject and greater than 50% in the remaining surviving subjects. The median progression-free survival time was 14 weeks (range: 0-22 weeks), and the median overall survival time was 32 weeks (range: 11-39 weeks).

CONCLUSIONS

Intratumoral STING agonist (IACS-8779) administration was well tolerated in dogs with glioblastoma to a dose of 15 μg. Higher doses of IACS-8779 were associated with radiographic responses.

Development of a veterinary trauma score (VetCOT) in canine trauma patients with performance evaluation and comparison to the animal trauma triage score: A VetCOT registry study

OBJECTIVE

To develop a population-derived, parsimonious, and objective risk stratification model for dogs following trauma and compare its predictive performance to the animal trauma triage (ATT) score.

DESIGN

Observational cohort study using data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) trauma registry acquired between September 2013 and October 2017.

SETTING

Nine Level I and Level II veterinary trauma centers.

ANIMALS

Nine hundred eighty-four dogs assessed within 24 h of traumatic injury.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patient mortality was 10.8%. The VetCOT model was constructed based on 4 variables: plasma lactate and ionized calcium obtained within 6 h of admission, and presence or absence of clinical signs consistent with either head or spinal trauma. The VetCOT score had good discriminatory performance (AUROC = 0.87, 95% CI = 0.83-0.91) comparable to that of the 6 variable ATT score for the same population (area under the receiver operator characteristic [AUROC] = 0.87; 95% CI, 0.84-0.90). No statistical difference in discriminatory performance between the 2 scores was identified (P = 0.98). The VetCOT score showed good calibration on this population (Hosmer-Lemeshow test P = 0.93), whereas the ATT score failed to calibrate (P = 0.02) due to overprediction of mortality at low scores. Sensitivity and specificity for outcome of the VetCOT score at a risk probability cutoff of 0.5 for this population were 28.97% and 97.95%, respectively.

CONCLUSIONS

The VetCOT score is a more parsimonious model with comparable discriminatory performance and superior calibration to the ATT score for risk stratification in dogs following trauma. Further prospective validation studies are required to confirm the discriminatory performance of the VetCOT score.

CT Findings and Histological Evaluation of Red Foxes (Vulpes vulpes) with Chronic Head Trauma Injury: A Retrospective Study

Large numbers of wild animals are injured every year in road traffic accidents. Scant data are available for rescued wild carnivores, in particular for red foxes. Cases of foxes with head trauma were retrospectively considered for inclusion in this study. Clinical examination, modified Glasgow coma scale (MGCS), computed tomography (CT) examination, therapy, outcome, and post mortem findings of the brain were investigated. In all foxes, cranial vaults lesion occurred in single (67%) or multiple sites (33%). Midline shift and hydrocephalus were observed in this population. The mean survival was 290 (±176) days. In our study, we performed CT scans on average 260 days after fox rescue, and we speculate that persisting clinical signs could be attributed to TBI. In our study, only two foxes were alive at the time of writing. Other foxes were euthanized due to the severity of the clinical signs. CT scans help diagnose chronic lesions and their effect on prognostic judgment for animals released to wildlife environments.

Shock index is associated with mortality in canine vehicular trauma patients

OBJECTIVE

To calculate and compare shock index (SI) in healthy dogs and vehicular trauma dogs (VT), determine the prognostic value of SI in VT dogs, and to assess the correlation between SI and the animal trauma triage score, modified Glasgow Coma Scale score, and lactate in VT dogs.

DESIGN

Retrospective study from April 2016 to February 2018.

SETTING

Twenty-four-hour tertiary referral level II trauma center.

ANIMALS

One hundred twenty-one dogs presented to the emergency service for VT and 60 healthy control dogs.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Heart rate and systolic blood pressure were measured on each patient and used to calculate SI. SI was significantly higher in VT dogs compared to healthy control dogs (median SI, 1.0 vs 0.75; P < 0.0001). SI was significantly higher in those that died versus those that survived to discharge (median, 1.27 vs 0.96; P = 0.017). SI positively correlated with animal trauma triage score (95% confidence interval, 0.039-0.49; P = 0.019; r = 0.26) but did not with plasma lactate level at presentation (P = 0.068; r = 0.22) or modified Glasgow Coma Scale (P = 0.85; r = -0.021, 95% confidence interval, -0.24 to 0.20).

CONCLUSIONS

SI is easy to calculate during triage of a trauma patient. Given its significant relationship with mortality, higher SIs should prompt the clinician to pursue additional monitoring, diagnostics, and intervention.

Serum Concentrations of Neuron-Specific Enolase in Dogs Following Traumatic Brain Injury

The ability to make an accurate prognosis, which is a prerequisite for treatment decisions, is very limited in dogs with traumatic brain injury (TBI). To determine whether serum concentrations of neuron-specific enolase (NSE) have prognostic value in dogs following TBI, we conducted a prospective, observational, controlled clinical study in an intensive care unit of a university teaching hospital. The study population comprised 24 dogs admitted to the hospital within 72 h of a known event of TBI between January 2010 and January 2015, as well as 25 control healthy shelter dogs admitted for elective neutering. Seventeen injured dogs (70%) survived to discharge, four were euthanized and three died within 48 h. Serum samples were obtained from all dogs (in injured dogs, within 72 h of TBI) and NSE concentrations were measured using enzyme-linked immonosorbent assay. Associations between NSE levels and outcome, Modified Glasgow Coma Scale, time to sampling, age or haemolysis scale were determined. Mean serum NSE concentrations were decreased in dogs with TBI compared with healthy controls (19.4 ± 4.14 ng/ml vs. 24.9 ± 4.6 ng/ml, P <0.001). No association was found between serum NSE concentrations and either survival or severity of neurological impairment. A negative correlation was found between serum NSE concentrations and time from trauma to blood collection (r = -0.50, P = 0.022). These results indicate that serum NSE concentration in dogs following TBI is not an effective marker for severity or outcome. Further studies are warranted to standardize serum NSE measurements in dogs and to determine the peak and half-life levels of this potential biomarker.

Thyroid axis and adrenal activity in 28 day survivor and nonsurvivor dogs involved in recent road traffic accidents: A cohort study of 420 dogs

The objective of this retrospective cohort study was to determine the impact of a recent trauma on thyroid axis and adrenal activity in dogs and to assess the usefulness of urinary cortisol-to-creatinine ratio (UCCR), basal serum thyroid-stimulating hormone (TSH), total thyroxine (tT4), and free thyroxine (fT4) concentrations in predicting outcome in dogs traumatized by a road traffic accident (RTA). An RTA exposed group of 210 dogs was evaluated within 24  hours of the trauma. Their data were compared with data from a matched group of dogs with other diagnoses. UCCR was positively correlated with the trauma severity and was higher in the exposed group than in the nonexposed group (median 101.500 vs. 21.02; p < 0.0001). tT4 values were statistically similar between the two groups, but were correlated with a trauma score, while TSH (median = 0.050 vs. 0.080 ng/mL; p < 0.0001) and fT4 (median = 15.850 vs. 17.950 pmol/L; p = 0.0037) were significantly lower for the exposed group. Nonsurvivors in comparison to survivors presented and higher median UCCR (181.800 vs. 93.850 respectively; p = 0.020), and a lower serum fT4 (12.700 vs. 16.500 pmol/L, respectively; p = 0.0046). A similar pattern had been observed for tT4. TSH levels were not predictive of survival. This study provides insights into the endocrine characteristics of dogs suffering from acute trauma. UCCR was higher while fT4 and TSH were both lower in RTA-injured dogs than in dogs affected by other conditions. Furthermore low fT4 and tT4, and a high UCCR could be useful prognostic factors in dogs affected by RTA trauma.

Pharmacokinetics of Sativex® in Dogs: Towards a Potential Cannabinoid-Based Therapy for Canine Disorders

The phytocannabinoid-based medicine Sativex^® is currently marketed for the treatment of spasticity and pain in multiple sclerosis patients and is being investigated for other central and peripheral pathological conditions. It may also serve in Veterinary Medicine for the treatment of domestic animals, in particular for dogs affected by different pathologies, including human-like pathological conditions. With the purpose of assessing different dosing paradigms for using Sativex in Veterinary Medicine, we investigated its pharmacokinetics when administered to naïve dogs via sublingual delivery. In the single dose arm of the study, adult Beagle dogs were treated with 3 consecutive sprays of Sativex, and blood samples were collected at 12 intervals up to 24 h later. In the multiple dose arm of the study, Beagle dogs received 3 sprays daily for 14 days, and blood samples were collected for 24 h post final dose. Blood was used to obtain plasma samples and to determine the levels of cannabidiol (CBD), Δ⁹-tetrahydrocannabinol (Δ⁹-THC) and its metabolite 11-hydroxy-Δ⁹-THC. Maximal plasma concentrations of both Δ⁹-THC (C_max = 18.5 ng/mL) and CBD (C_max = 10.5 ng/mL) were achieved 2 h after administration in the single dose condition and at 1 h in the multiple dose treatment (Δ⁹-THC: C_max = 24.5 ng/mL; CBD: C_max = 15.2 ng/mL). 11-hydroxy-Δ⁹-THC, which is mainly formed in the liver from Δ⁹-THC, was almost undetected, which is consistent with the use of sublingual delivery. A potential progressive accumulation of both CBD and Δ⁹-THC was detected following repeated exposure, with maximum plasma concentrations for both cannabinoids being achieved following multiple dose. Neurological status, body temperature, respiratory rate and some hemodynamic parameters were also recorded in both conditions, but in general, no changes were observed. In conclusion, this study demonstrates that single or multiple dose sublingual administration of Sativex to naïve dogs results in the expected pharmacokinetic profile, with maximal levels of phytocannabinoids detected at 1–2 h and suggested progressive accumulation after the multiple dose treatment.

VetCOT: The Veterinary Trauma Registry

The goals of the Veterinary Committee on Trauma (VetCOT) trauma registry are to (1) inform improvement of veterinary and human trauma patient care and (2) design clinical and preclinical trials that could inform go/no go decisions for interventional strategies and tools. The VetCOT registry was established in 2013, and includes all trauma cases that present to Veterinary Trauma Centers. Veterinary Trauma Centers are well-resourced veterinary hospitals that are initially identified, then subsequently verified, by the American College of Veterinary and Emergency Critical Care VetCOT (http://vetcot.org/index.php/home/identification-and-verification-process/). As of June 2019, there are > 40,000 dog and cat cases in the registry, 3 publications and 9 ongoing projects utilizing data from the registry. Application materials to utilize VetCOT registry data is available on the VetCOT website (http://vetcot.org/index.php/home/registry-use-materials/).

ACVECC-Veterinary Committee on Trauma Registry Report 2013-2017

OBJECTIVE

To report summative data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) registry.

DESIGN

Multi-institutional veterinary trauma registry data report.

SETTING

VetCOT identified veterinary trauma centers (VTCs).

ANIMALS

Dogs and cats with evidence of trauma presented to VTCs with data entered in the VetCOT registry September 1, 2013-March 31, 2017.

INTERVENTIONS

VetCOT created a standardized data collection methodology for dog and cat trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in data software use and operational definitions of data variables. Data on demographics, trauma type (blunt vs penetrating), preadmission care, hospitalization and intensive care requirement, trauma severity assessment at presentation (eg, modified Glasgow coma scale and animal trauma triage score), key laboratory parameters, necessity for surgical intervention, and case outcome were collected. Summary descriptive data for each species are reported.

MEASUREMENTS AND MAIN RESULTS

Twenty-nine VTCs in North America, Europe, and Australia contributed information from 17,335 dog and 3,425 cat trauma cases during the 42-month reporting period. A large majority of cases presented directly to the VTC after injury (80.4% dogs and 78.1% cats). Blunt trauma was the most common source for injury in cats (56.7%); penetrating trauma was the most common source for injury in dogs (52.3%). Note that 43.8% of dogs and 36.2% of cats were reported to have surgery performed. The proportion surviving to discharge was 92.0% (dogs) and 82.5% (cats).

CONCLUSIONS

The VetCOT registry proved to be a powerful resource for collection of a large dataset on trauma in dogs and cats seen at VTCs. While overall survival to discharge was quite high, further evaluation of data on subsets of injury types, patient assessment parameters, interventions, and associated outcome are warranted.

High Mobility Group Box-1 and Pro-inflammatory Cytokines Are Increased in Dogs After Trauma but Do Not Predict Survival

Trauma is common in dogs and causes significant morbidity and mortality, but it remains challenging to predict the prognosis of dogs with traumatic injuries. This study aimed to quantify plasma high-mobility group box-1 (HMGB-1) and cytokine concentrations in dogs with moderate-to-severe trauma, and to evaluate the association between these biomarkers and the injury severity and survival to discharge. Using a prospective, observational case-control study design, 49 dogs with an animal trauma triage (ATT) score ≥3 were consecutively enrolled from 07/2015 to 10/2017 and followed to hospital discharge. Dogs <3 kg and those with pre-existing coagulopathies were excluded. Thirty three healthy control dogs were also enrolled. Illness and injury severity scores including the acute patient physiologic and laboratory evaluation (APPLE) were calculated using at-presentation data. Plasma HMGB-1 concentrations were measured by ELISA; concentrations of 13 cytokines were measured using multiplex bead-based assays and separately concentrations of 4 cytokines were measured using a multiplex canine-specific ELISA. All biomarkers were measured in duplicate. Mann-Whitney U tests were used to compare biomarker concentrations between groups and between survivors and non-survivors. Associations between biomarkers were evaluated using Spearman's correlation coefficients. Independent predictors of survival were identified using multivariable logistic regression. Alpha was set at 0.05. Plasma concentrations of HMGB-1, interleukin-6, C-X-C motif chemokine-8, keratinocyte chemoattractant-like, and C-C chemokine ligand-2 were significantly greater in injured dogs vs. controls (all P ≤ 0.011). In univariate analyses, HMGB-1 was significantly greater in non-survivors 46.67 ng/mL (8.94-84.73) compared to survivors 6.03 ng/mL (3.30-15.75), (P = 0.003). Neither HMGB-1 or the cytokines were associated with survival independent of illness severity as measured by the APPLE score, however.

Concentrations of Plasma Nucleosomes but Not Cell-Free DNA Are Prognostic in Dogs Following Trauma

Trauma is common in dogs and causes significant morbidity and mortality, but it remains a challenge to assess prognosis in these patients. This study aimed to investigate the use of plasma cell-free DNA (cfDNA) and nucleosome concentrations as prognostic biomarkers in canine trauma. Using a prospective, observational case-control study design, 49 dogs with trauma were consecutively enrolled from 07/2015 to 10/2017 and followed to hospital discharge. Dogs with animal trauma triage (ATT) scores ≥3 at presentation were eligible for enrollment. Dogs <3 kg or with pre-existing coagulopathies were excluded. Thirty-three healthy control dogs were also enrolled. Illness and injury severity scores were calculated using at-presentation data. Plasma cfDNA was measured in triplicate using a benchtop fluorimeter. Plasma nucleosome concentrations were determined in duplicate by ELISA. Mann-Whitney U tests were used to compare biomarker concentrations between groups and between survivors and non-survivors. Associations between biomarkers were evaluated using Spearman's correlation coefficients. Alpha was set at 0.05. Concentrations of cfDNA and nucleosomes were significantly higher in injured dogs compared to healthy controls (P ≤ 0.0001). Nucleosomes and cfDNA concentrations were positively correlated (rs 0.475, P < 0.001). Concentrations of both cfDNA and nucleosomes were correlated with shock index (rs 0.367, P = 0.010, rs 0.358, P = 0.012 respectively), but only nucleosomes were correlated with ATT (rs 0.327, P = 0.022) and acute patient physiology and laboratory evaluation (APPLE) scores (rs 0.356, P = 0.012). Median nucleosome concentrations were significantly higher in non-survivors than in survivors [8.2 AU (3.1-26.4) vs. 1.6 AU (0.5-5.2); P = 0.01]. Among illness severity scores, only APPLE was discriminant for survival (AUROC 0.912, P < 0.001). In summary, in moderately-severely injured dogs, high nucleosome concentrations are significantly associated with non-survival.