title: Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study.
abstract: The objective of this cross-sectional study was to compare the prevalence of selected clinical signs in laminitis cases and non-laminitic but lame controls to evaluate their capability to discriminate laminitis from other causes of lameness. Participating veterinary practitioners completed a checklist of laminitis-associated clinical signs identified by literature review. Cases were defined as horses/ponies with veterinary-diagnosed, clinically apparent laminitis; controls were horses/ponies with any lameness other than laminitis. Associations were tested by logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals, with veterinary practice as an a priori fixed effect. Multivariable analysis using graphical classification tree-based statistical models linked laminitis prevalence with specific combinations of clinical signs. Data were collected for 588 cases and 201 controls. Five clinical signs had a difference in prevalence of greater than +50 per cent: 'reluctance to walk' (OR 4.4), 'short, stilted gait at walk' (OR 9.4), 'difficulty turning' (OR 16.9), 'shifting weight' (OR 17.7) and 'increased digital pulse' (OR 13.2) (all P<0.001). 'Bilateral forelimb lameness' was the best discriminator; 92 per cent of animals with this clinical sign had laminitis (OR 40.5, P<0.001). If, in addition, horses/ponies had an 'increased digital pulse', 99 per cent were identified as laminitis. 'Presence of a flat/convex sole' also significantly enhanced clinical diagnosis discrimination (OR 15.5, P<0.001). This is the first epidemiological laminitis study to use decision-tree analysis, providing the first evidence base for evaluating clinical signs to differentially diagnose laminitis from other causes of lameness. Improved evaluation of the clinical signs displayed by laminitic animals examined by first-opinion practitioners will lead to equine welfare improvements.
authors.affiliation: Epidemiology Department, Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, UK Rossdales Equine Hospital, Cotton End Road, Exning, Newmarket, Suffolk, UK.
authors.forename: C E
authors.identifier: http://orcid.org/0000-0001-8076-4235
authors.initials: CE
authors.lastname: Wylie
authors.affiliation: Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Shaw
authors.affiliation: Veterinary Epidemiology, Economics and Public Health Group, Department of Production and Population Health, Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, UK.
authors.forename: K L P
authors.initials: KL
authors.lastname: Verheyen
authors.affiliation: Epidemiology Department, Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Newton
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003663:Decision Trees; D003937:Diagnosis, Differential; D005534:Foot Diseases / Q000175:diagnosis / Q000662:veterinary*; D006724:Hoof and Claw; D006734:Horse Diseases / Q000175:diagnosis*; D006736:Horses; D007794:Lameness, Animal / Q000209:etiology*
keywords: Clinical practice; Epidemiology; Horses; Lameness; Laminitis