title: Prospective study of the primary evaluation of 1016 horses with clinical signs of abdominal pain by veterinary practitioners, and the differentiation of critical and non-critical cases.
abstract: BACKGROUND
  The majority of research on the evaluation of horses with colic is focused on referral hospital populations. Early identification of critical cases is important to optimise outcome and welfare. The aim of this prospective study was to survey the primary evaluation of horses with clinical signs of abdominal pain by veterinary practitioners, and compare the initial presentation of critical and non-critical cases.
  
  
  RESULTS
  Data from 1016 primary evaluations of horses presenting with clinical signs of colic were submitted by 167 veterinary practitioners across the United Kingdom over a 13 month period. The mean age of the study population was 13.5 years (median 12.0, range 0-42). Mean heart rate on primary presentation was 47 beats/min (median 44, range 18-125), mean respiratory rate was 20 breaths/min (median 16, range 6-100), and median gastrointestinal auscultation score (0-12, minimum-maximum) was 5 (range 0-12). Clinical signs assessed using a behavioural severity score (0-17, minimum-maximum), were between 0 and 6 in 70.4 % of cases, and 7-12 for 29.6 % of cases. Rectal examination was performed in 73.8 % of cases. Cases that responded positively to simple medical treatment were categorised retrospectively as 'non-critical'; cases that required intensive medical treatment, surgical intervention, died or were euthanased were categorised as 'critical'. Eight-hundred-and-twenty-two cases met these criteria; 76.4 % were 'non-critical' and 23.6 % were 'critical'. Multivariable logistic regression was used to identify features of the clinical presentation associated with critical cases. Five variables were retained in the final multivariable model: combined pain score: (OR 1.19, P < 0.001, 95 % CI 1.09-1.30), heart rate (OR 1.06, P < 0.001, 95 % CI 1.04-1.08), capillary refill time >2.5 s (OR 3.21, P = 0.046, 95 % CI 1.023-10.09), weak pulse character (OR 2.90, P = 0.004, 95 % CI 1.39-5.99) and absence of gut sounds in ≥1 quadrant (OR 3.65, P < 0.001, 95 % CI 2.08-6.41).
  
  
  CONCLUSIONS
  This is the first study comparing the primary presentation of critical and non-critical cases of abdominal pain. Pain, heart rate, gastrointestinal borborygmi and simple indicators of hypovolaemia were significant indicators of critical cases, even at the primary veterinary examination, and should be considered essential components of the initial assessment and triage of horses presenting with colic.
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. lailacurtis@hotmail.co.uk.
authors.forename: Laila
authors.initials: L
authors.lastname: Curtis
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. john.burford@nottingham.ac.uk.
authors.forename: John Harold
authors.initials: JH
authors.lastname: Burford
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. svyjt@exmail.nottingham.ac.uk.
authors.forename: Jennifer Sara Marian
authors.initials: JS
authors.lastname: Thomas
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. curran.marise@pdsa.org.uk.
authors.forename: Marise Linda
authors.initials: ML
authors.lastname: Curran
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. tom.bayes@live.com.
authors.forename: Tom Curtis
authors.initials: TC
authors.lastname: Bayes
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. gary.england@nottingham.ac.uk.
authors.forename: Gary Crane William
authors.initials: GC
authors.lastname: England
authors.affiliation: School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Loughborough, LE, LE12 5RD, UK. sarah.freeman@nottingham.ac.uk.
authors.forename: Sarah Louise
authors.initials: SL
authors.lastname: Freeman
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D000818:Animals; D003085:Colic / Q000175:diagnosis / Q000209:etiology / Q000662:veterinary*; D003625:Data Collection; D005260:Female; D006734:Horse Diseases / Q000175:diagnosis* / Q000209:etiology; D006736:Horses; D008297:Male; D011446:Prospective Studies; D018634:Veterinarians / Q000706:statistics & numerical data