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Veterinary Practitioners' Selection of Diagnostic Tests for the Primary Evaluation of Colic in the Horse L

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Veterinary Practitioners' Selection of Diagnostic Tests for the Primary Evaluation of Colic in the Horse L Downloaded from http://vetrecordopen.bmj.com/ on November 10, 2015 - Published by group.bmj.com Horses and other equids Veterinary practitioners’ selection of diagnostic tests for the primary evaluation of colic in the horse L. Curtis, I. Trewin, G. C. W. England, J. H. Burford, S. L. Freeman To cite: Curtis L, et al. ABSTRACT abdominal pain, but other conditions such as ’ Veterinary practitioners The aim of this study was to survey veterinary thoracic pain can have similarities in presenta- selection of diagnostic tests practitioners’ selection of diagnostic tests for horses tion (false colic). An early and accurate diag- for the primary evaluation of with clinical signs of abdominal pain. A questionnaire colic in the horse. Vet Rec nosis is particularly important for critical cases, was distributed to veterinary surgeons involved in the Open 2015;2:e000145. where the degree, duration and severity of doi:10.1136/vetreco-2015- primary evaluation of horses with abdominal pain, ’ pathology will impact upon outcome. 000145 including the respondent s demographics, selection of diagnostic tests and factors affecting decision-making. Many diagnostic tests can be used to evalu- Data analysis included descriptive analysis, ate horses with abdominal pain, and these ▸ Prepublication history and categorisation of free text and simple univariable vary in their cost and the facilities and level additional material is of expertise required to perform the techni- available. To view please visit correlations to explore the relationships between the journal online independent variables and the relative self-estimated ques and interpreting outcomes. The (http://dx.doi.org/10.1136/ frequency that diagnostic tests were performed. A total current research evaluating diagnostic tests vetreco-2015-000145). of 228 responses were analysed. Participants worked for horses with clinical signs of abdominal in mixed practice (55.7 per cent), first opinion equine pain is focused on referral hospital popula- Received 30 May 2015 (22.8 per cent), first and second opinion equine (17.9 Revised 6 August 2015 tions. There is limited evidence relating to per cent) and referral practice (3.1 per cent). The diagnostic approach at the first evaluation of Accepted 12 August 2015 majority (48.2 per cent, 105/218) were very confident cases; most information is only available from managing a colic case (confidence level 4/5). The most This final article is available ‘ reviews and textbooks (Greatorex 1972, for use under the terms of frequently used diagnostic tests were response to ’ Wilson and Gordon 1987, Archer 2004, the Creative Commons analgesia (87.2±24.0 per cent cases), rectal Attribution Non-Commercial examination (75.9±21.2 per cent) and nasogastric Southwood and Fehr 2012). The primary 3.0 Licence; see intubation (43.8±27.6 per cent). Approach varied evaluation of horses with abdominal pain is http://vetreco.bmj.com between practitioners, and for all diagnostic tests with usually an emergency consultation in the frequency of use ranging from 0 to 100 per cent of field environment, often with limited facil- cases. ‘Risk to personal safety’ was the most common ities and financial restrictions. Factors such reason for not using rectal examination. Practitioner’s as temperament of the horse and availability opinion of their confidence level in managing a colic and cost of diagnostic equipment may have a case was associated with how frequently they used significant impact on the diagnostic tests different diagnostic tests. There was marked variation employed and decisions made. in practitioners’ approaches, highlighting the need for further evidence to support decision-making. The aim of this study was to survey veterin- ary practitioners’ selection of diagnostic tests for horses with clinical signs of abdominal pain. The objectives of the study were: INTRODUCTION ▸ to survey veterinary practitioners’ selec- Colic is of high welfare and economic concern tion of diagnostic tests for the primary (Traub-Dargatz and others 2001, Egenvall and evaluation of horses presenting with clin- others 2008), and has been ranked as the most ical signs of abdominal pain; important emergency problem by both owners ▸ to identify which factors influence veterin- School of Veterinary ’ Medicine and Science, and veterinary surgeons (Traub-Dargatz and ary practitioners decision-making in University of Nottingham, others 1991, Bowden and others 2014). ‘Colic’ choosing diagnostic tests for horses with Loughborough, refers to the clinical signs of abdominal pain; clinical signs of abdominal pain; Leicestershire, UK this has many different aetiologies, and there- ▸ to determine whether there is an associ- ’ Correspondence to fore, assessment of the nature of the disease ation between veterinary practitioners Dr S. L. Freeman; sarah. can be extremely challenging (Dukti and background and experience and their [email protected] White 2009). Clinical signs usually relate to choice of diagnostic tests. Curtis L, et al. Vet Rec Open 2015;2:e000145. doi:10.1136/vetreco-2015-000145 1 Downloaded from http://vetrecordopen.bmj.com/ on November 10, 2015 - Published by group.bmj.com Open Access MATERIALS AND METHODS were also given a free text option to identify and Survey distribution describe other diagnostic tests they would use. A copy of A survey of UK equine practitioners was carried out the questionnaire is available in online supplementary using a mixed methods questionnaire. Online and file 1. paper-based versions of the questionnaire were distribu- ted to all UK practitioners with an equine client base, identified from the Royal College of Veterinary Data analysis Surgeons (RCVS) database, and to all practitioners par- Data were exported from the online response portal ticipating in a survey of the primary evaluation of colic (Adobe Forms Central) or input manually for postal cases (Curtis and others 2014). Veterinary practitioners forms into a spreadsheet (Excel 2010, Microsoft were asked to complete the questionnaire if they saw any Corporation, Washington, USA). Descriptive data ana- cases of equine colic as part of their veterinary work. lyses, including mean, median, mode and range values, The questionnaire could be completed and returned in were displayed in graphs and tables. Data were tested for either paper-based format or in an online format normality using QQ plots. Free text responses for a total (Adobe Forms Central, Adobe Systems, California, of 26 open questions within the questionnaire were USA). The online version of the survey was open from reviewed, categorised and ranked into order of fre- October 17 to November 15, 2013. Postal questionnaires quency for each category. The reasons why practitioners were distributed on October 28–30, 2013. A follow-up did not use each diagnostic test were analysed to deter- email was sent out two weeks prior to the study’s closure mine both the primary reason for not using the test fi to veterinary surgeons and veterinary practices, remind- (how frequently each reason was ranked rst by respon- ing them to complete the questionnaire. dents) and the total frequency for each reason (total number of times each reason was given, irrespective of Questionnaire design ranking; respondents could list up to three reasons for ’ All participants were asked to complete a consent form each test). Spearman s rank correlation (ordinal data) ’ fi at the start of the questionnaire, consistent with current and Pearson s correlation coef cient (continuous data) guidelines (1998 Data Protection Act, BERA Ethical (SPSS V.21 or 22; IBM, New York, USA) were used to ’ Guidelines 2011, and Statement for Ethical Practice for evaluate statistical associations between the participants fi fi the BSA 2002). The questionnaire consisted of both demographics (number of years quali ed, con dence of open and closed questions. The first questions related to practitioner, type of employment) and how frequently the demographics of the veterinary practitioner. This they estimated that they used each diagnostic test. included the year the respondent graduated, the type of Evidence of association was accepted if P<0.05. practice where they worked (categorised into mixed (any combination of species), equine first opinion, equine first and second opinion, equine referral and RESULTS other) and the estimated number of colic cases the An email containing the link to the questionnaire was respondents examined each month. Colic was defined as sent to 943 veterinary surgeons, and paper-based copies clinical signs of abdominal pain, and the study specified of the questionnaire were posted to 985 practitioners/ that this survey only related to gastrointestinal causes of practices (which included some of the practitioners who abdominal pain. were emailed directly). In total, 112 questionnaires were The next section related to practitioners’ diagnostic returned online (response rate of 11.9 per cent) and approach. This included how frequently they estimated 136 paper-based responses were returned by post that they used six different diagnostic tests (estimated (response rate of 13.8 per cent), producing an overall percentage of cases in which they used rectal examin- total of 248 responses. A percentage response rate was ation, abdominal paracentesis, nasogastric intubation, not calculated due to the overlap between contacting haematology and biochemistry, ultrasound examination practices and practitioners, which meant the total and response to analgesia/treatment on the primary number of vets contacted could not be calculated. assessment of horses with clinical signs of abdominal Fifteen postal respondents did not complete the ethics pain), the scenarios in which they would use each test statement section, and five respondents were not based and the reasons for not using diagnostic tests (including in the UK. These responses were excluded; therefore, the main primary reason and up to two other reasons 228 responses were used for the final data analysis. why they would not use a diagnostic test). The scenarios Some participants did not complete all sections; there- in which they would use each test were open free text fore, the total number of responses is given for each questions.
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