FLASH SCANNING IN FIRST OPINION COLIC


when made, was recorded based on findings from all investigative procedures performed by the clinical team attending to the animals during their care. Data were cleaned within Excel and exported into a statistical


software for analysis (Stata 17.0). Continuous variables were as- sessed for normality graphically and using the Shapiro–wilk test. Median, interquartile range (IQR) and range were reported for skewed data. Categorical data were reported as counts and corre- sponding percentages. Univariable binary logistic regression was used to assess associations between risk factors (age and FLASH findings) and survival at 48 h after examination or survival to hos- pital discharge in horses with colic (categorised as euthanised or resolved). Risk factors considered to be at least weakly associated with survival ( p < 0.2) were used for multivariable logistic regression analysis.


RESULTS


One hundred and thirty- four horses and one donkey were prospec- tively enrolled into the study. Each animal was included as a case only once. They had a mean age of 16.4 years (range 4 months–32 years). The breed was recorded in 116 animals and included 37 ponies, 29 warmbloods/crosses, 15 Thoroughbreds/crosses, 17 cobs/crosses, 13 sport horses, 3 draught horses, one Quarter Horse and one don- key. Sex was recorded in 134 cases, of which 67 (50%) were males (65 geldings and 2 entire males) and 67 (50%) were females. In total 12/135 (9%) animals underwent surgical treatment. Of


the 135 animals, 85 (63%) survived, including 5 that underwent sur- gical treatment and 50 (37%) died or were euthanised, including 7 that underwent surgical treatment. FLASH images were obtained in all 135 animals examined. Although it was not possible to obtain fully diagnostic images of all 7 topographical locations in every case (due to excessively long haircoats, mud, etc), images considered to be of appropriate diagnostic quality were acquired in every animal. Of the 135 cases, 34 (25%) had distended loops of small intestine (luminal diameter ≥5.0 cm) (mean luminal diameter of these 34 cases 6.5 cm, range 5.0–9.4 cm) and 23 (16%) had thickened small intestinal walls (>3.0 mm) (mean wall thickness of these 23 cases 8.1 mm, range 3.3–23.0 mm). Distension of the stomach (stomach observed in >5 intercostal spaces) was recorded in 7 animals (5%) (mean number of intercostal spaces over which the stomach was visible 6.7, range 6–8). Reduced or absent small intestinal motility was recorded in 52 cases. Of the 34 horses with distended small intestine, 25 were euthanised without surgery due to clinical deterioration and owner decision, 4 recovered with medical treatment, 4 underwent surgery but did not survive and one underwent surgery and survived. Of these 34 cases, 19 were suspected to have small intestinal strangulation (not con- firmed), 7 had confirmed small intestinal strangulation (confirmed either at surgery or post- mortem examination), 7 had no diagnosis and one had confirmed equine grass sickness. Of the 23 horses with thickened small intestinal walls, 11 were euthanised without surgery due to clinical deterioration, 7 recovered with medical treatment,


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2 underwent surgery but did not survive and 3 underwent surgery and survived. Of these 23 cases, 8 were suspected to have small intestinal strangulation (not confirmed), 5 had confirmed small in- testinal strangulation (confirmed either at surgery or post- mortem examination), 2 had suspected enteritis, one had a pelvic flexure im- paction, one had a faecalith obstruction, one had a rectal tear and 5 had no diagnosis. Of the 7 horses with distension of the stomach, 5 were euthanised without surgery due to clinical deterioration and 2 underwent surgery and survived. Of these 7 cases, 4 were sus- pected to have small intestinal strangulation (not confirmed), 2 had confirmed small intestinal strangulation (confirmed either at surgery or post- mortem examination), and one had confirmed equine grass sickness. Of the 52 horses with reduced/absent small intestinal mo- tility, 27 were euthanised without surgery due to clinical deterio- ration, 18 recovered with medical treatment, 2 underwent surgery and survived and 4 underwent surgery but did not survive. Of these 52 cases, 20 were suspected to have small intestinal strangulation (not confirmed), 6 had confirmed small intestinal strangulation (con- firmed either at surgery or post- mortem examination), 20 had no diagnosis, 3 had suspected large colon displacements/torsion, one had a rectal tear, one had a pelvic flexure impaction and one had confirmed equine grass sickness. Seventeen horses had suspected large colon displacement based on the results of rectal examination and/or the FLASH examination (11 suspected right dorsal displace- ment, 5 suspected left dorsal displacement and one suspect colon torsion). The left kidney was not identifiable ultrasonographically in the 5 horses with suspected left dorsal displacement of the large colon. Thickening of the colon wall was observed in 2/11 horses with suspected right dorsal displacement and in the single horse with sus- pected colon torsion. Of these 17 horses, 12 recovered with medical treatment and 5 were euthanised due to clinical deterioration and the absence of a surgical option. No cases with ultrasonographic abnormalities in the thoracic window or duodenal window were re- corded. Increased peritoneal fluid was recorded in two cases (one horse with a rectal tear and one horse with a suspected small in- testinal strangulation). Overall, 35 of 50 horses that did not survive (70%) had abnormalities detected on FLASH examination, whereas 15 (30%) had no identifiable abnormalities. The results of univariable and multivariable analyses of associ-


ations between FLASH findings and odds of survival after 48 h are shown in Tables 1 and 2 . Age of the animals was strongly associ- ated with the odds of survival, with increasing age increasing the likelihood of not surviving to discharge (Odds ratio [OR] 1.10; 95% confidence interval 1.05–1.16). When all factors were included in a multivariable model (accounting for age as a confounding fac- tor), only small intestinal distension ( p = 0.001) remained signifi- cant, therefore this appears to be the FLASH finding that was most strongly associated with non- survival. Stomach distension was not included due to the small numbers. The association with reduced small intestinal motility was accounted for after considering small intestinal distension. Small intestinal wall thickness was weakly sig- nificant ( p = 0.087) in the final model; there was no change in the odds ratio so was unlikely confounded in the final model but instead


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