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requiring surgery is one of the most important determinants of out- come (Dukti & White, 2009 ; Freeman et al., 2014 ; Klohnen, 2012 ; Rudnick et al., 2022 ; Southwood, 2023 ). In addition to a full physical examination, additional diagnos-
tic tests commonly undertaken to assess horses with colic include rectal examination and nasogastric intubation (Bowden, Boynova, et al., 2020 ; Bowden, England, et al., 2020 ). Over the past few de- cades, transabdominal ultrasonography has become established as a valuable ancillary diagnostic procedure and is commonly performed at referral hospitals as part of the diagnostic workup of colic cases (Desrochers & White, 2017 ; Waxman, 2020 ); however, it is uncom- monly performed or reported in first opinion practice (Bowden, Boynova, et al., 2020 ; Bowden, England, et al., 2020 ). A systematic approach to ultrasound scanning of the abdomen was described by Beccati et al. ( 2011 ). However, carrying out comprehensive and detailed ultrasonography of the abdomen is time- consuming, even for experienced operators (le Jeune & Whitcomb, 2014 ), and may not be appropriate in an emergency setting. Point- of- care ultra- sound (POCUS) or clinician- performed ultrasound (CPUS) (Baston et al., 2019 ) protocols are increasingly used in veterinary and human medicine because of technological and training advances. Focused ultrasonographic protocols are time- sensitive, goal- oriented assess- ments that answer focused clinical questions based on a patient ' s clinical signs. A POCUS procedure for use in equine colic was re- ported by Busoni and colleagues ( 2011 ), described as ‘Fast Localised Abdominal Ultra- Sonography of Horses’ (FLASH). The goal of the FLASH protocol is to quickly assess horses with colic by examining seven key abdominal areas. Busoni et al. ( 2011 ) reported 88.89% and 81.48% positive and negative predictive values respectively in determining the requirement for surgical intervention due to small intestinal obstruction using the FLASH procedure to identify dilated small intestinal loops. The full ultrasound protocol and the FLASH protocol have comparable sensitivity and specificity for identifying small and large intestinal lesions requiring surgery (Fairburn, 2017 ). As technology improves, ultrasound scanners are becoming more
portable and affordable in the ambulatory setting (Gilsenan, 2021 ), making this modality more readily available for the initial assessment of colic cases in the field. However, there is a lack of data regarding the value of the FLASH procedure in evaluating horses with colic in first opinion ambulatory practice. The objective of this preliminary study was to describe the findings from FLASH scanning in the pri- mary assessment of equids with colic attending first opinion equine practice, using a portable wireless ultrasound system. A secondary objective was to understand whether FLASH scanning findings were associated with survival.
MATERIALS AND METHODS
Any horse or donkey presenting for emergency colic examination by two veterinarians (SC and KC) in an out- of- hours first opinion ambu- latory setting in the southeast of England was eligible for inclusion in the study. Horses were enrolled on the study once specific owner
CORRIE ET AL.
consent had been obtained. In addition to a standard clinical exami- nation for colic (Desrochers & White, 2017 ), the horses underwent FLASH examination as described previously (Busoni et al., 2011 ); the FLASH procedure was completed prior to passing a nasogastric tube in those cases where this was performed. The two veterinar- ians were both experienced in the use of abdominal ultrasonography since prior to the start of the study they had both routinely per- formed regular FLASH examinations on horses with colic presenting to a referral hospital. The FLASH examination was performed using a Sonon 300C por-
table ultrasound scanner (Orca Medical) with a 3.5 MHz curvilinear probe. The images were displayed on a smartphone or tablet (Apple iphone/ipad). Alcohol was applied to the skin to improve probe- to- skin contact. Clipping the hair was not routinely performed but was required in a minority of animals that had excessively long haircoats. Seven topographical locations were assessed, as described previ- ously (Busoni et al., 2011 ): (1) ventral abdomen; (2) gastric window; (3) splenorenal window; (4) left middle third of the abdomen; (5) du- odenal window; (6) right middle third of the abdomen; and (7) tho- racic window. Any abnormal ultrasound findings identified in these areas were recorded. Abnormalities noted in the duodenal window were combined with those observed in the small intestine seen more ventrally. Normal small intestinal (jejunal) wall thickness was defined as up to 3 mm (Beccati et al., 2011 ; Klohnen et al., 1996 ; Scharner et al., 2002 ). Small intestinal distension was defined as a luminal diameter greater or equal to 5 cm (Le Jeune & Whitcomb, 2014 ; Scharner et al., 2002 ). Small intestinal motility was subjectively as- sessed on ultrasound and recorded as normal or reduced/absent. Gastric distension was defined as the visibility of the stomach wall in more than 5 intercostal spaces (Reef, 1998 ). The maximum circum- ference of any dilated small intestine, maximum small intestinal wall thickness, assessment of small intestinal motility and stomach size (number of intercostal spaces over which the stomach was visible in the gastric window on the left side of the abdomen) were recorded. Additionally, if any large intestinal abnormality was suspected either by rectal palpation or by ultrasonography (e.g. mucosal oedema of the colon wall suggestive of large colon volvulus [Pease et al., 2004 ]) this was also recorded. In all cases, the signalment was recorded, along with any rectal findings and the result of abdominocentesis, if performed. The outcome of the case over the following 48 h was recorded as either resolved with medical management or referred for intensive care/surgery, or euthanasia. The decision to perform euthanasia was determined jointly by the owner of the horse and the attending veterinarian, based on the clinical presentation/pro- gression of the case, the rectal examination findings, peritoneal fluid analysis, as well as welfare and financial considerations (i.e. in some cases euthanasia was undertaken because owners were unable/ unwilling to commit to surgical treatment due to cost); the decision to perform euthanasia was not determined solely by the ultrasound findings in any case. In animals that were referred to a hospital, the final decision to perform surgery or euthanasia was determined by the clinical team at the referral hospital, independently of the two veterinarians performing the FLASH scanning. The final diagnosis,
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