574
|
Variable Age
Increased small intestinal wall thickness Small intestinal distension Decreased/absent small intestinal motility Stomach distension Category
Median (IQR) Yes No Yes No Yes No Yes No
Died or euthanased, N = 50
22 years (IQR 16–25) 13 (26.0%) 37 (74.0%) 29 (58.0%) 21 (42.0%) 19 (38.0%) 31 (62.0%) 6 (12.0%) 44 (88.0%)
Resolved, N = 85
13 (IQR 7–20) 10 (11.8%) 75 (88.2%) 5 (5.8%)
80 (94.1%) 64 (75.3%) 21 (24.7%) 1 (1.2%)
84 (98.8%)
CORRIE ET AL.
TABLE 1 Results of univariable analysis of associations of age and FLASH scanning findings with non- survival in horses examined as an emergency for colic in primary equine practice.
OR (95% CI)
1.10 (1.05–1.16) 2.6 (1.1–6.6) —
22.1 (7.6–64.0) —
5.0 (2.3–10.6) —
11.5 (1.3–98.2) —
Note : There were a small number of cases where every variable was not recorded – these have been classified as normal.
TABLE 2 Results of multivariable analysis of associations of FLASH scanning findings with non- survival in horses examined as an emergency for colic in primary equine practice, after accounting for age. Variable
Category Age Increased small intestinal wall thickness Small intestinal distension Decreased/absent small intestinal motility
Continuous, linear Yes No Yes No Yes No
the multivariable analysis was underpowered to detect a difference due to smaller numbers.
DISCUSSION
The results of this small preliminary study indicate that transab- dominal ultrasonography of horses and donkeys with colic using the FLASH protocol is readily adaptable to use in first opinion practice. The FLASH examination, being a form of POCUS, is goal- directed, meaning that its purpose is not to perform a complete ultrasound examination, but to answer specific objective questions; these are generally binary in nature, with yes/no answers rather than rely- ing on operator interpretation. This in turn means that acquisition of competency is quick (Kwon et al., 2019 ). Although both clinicians who performed the FLASH examinations in this study were experi- enced in performing this type of examination, it was readily incor- porated into the colic assessment and was not considered to have any negative impact on patient or client care. The exact time taken to perform the FLASH scanning was not recorded in this study, but in the original description of the procedure (Busoni et al., 2011 ), it was completed within a mean of 10.7 min, which was estimated to be similar to the present study. The study by Busoni et al. ( 2011 ) reported high sensitivity and specificity (80% and 96.15% respectively) for identifying dilated
OR (95% CI)
1.10 (1.04–1.17) 3.0 (0.9–10.1) —
12.6 (3.4–44.3) —
1.8 (0.6–5.2) —
p - Value <0.001
0.038 <0.001 <0.001 0.026
p - Value 0.002
0.079 <0.001 0.272
small intestine caused by a small intestinal obstruction. These au- thors concluded that the FLASH technique is a valuable resource for the veterinarian to detect major intra- abdominal pathology in an emergency situation, and our results support this conclusion, although sensitivity and specificity could not be determined in the current study. The use of the FLASH scan technique allows for prompt assessment of possible intestinal lesions and obstructions, and aids rapid decision- making to determine if surgery is required. Being able to save time in colic assessment and treatment promptly has a direct correlation to survival (Freeman et al., 2014 ; Mair & Smith, 2005 ; Rudnick et al., 2022 ; Southwood, 2023 ). The most im- portant contributing factor to a successful outcome for horses with intestinal strangulation is early identification and prompt surgical correction of the lesion. Irreversible intestinal injury occurs within hours of strangulation, and in some cases, death can occur within 3–4 h (Southwood, 2023 ). Early identification of intestinal strangula- tions also permits prompt euthanasia of animals where surgery, for whatever reason, is not an option, thereby having important welfare benefits. Small intestinal distension was the FLASH finding that was most
strongly associated with non- survival in this study. This observa- tion is compatible with the results of other studies based at referral centres (Beccati et al., 2011 ; Busoni et al., 2011 ; Klohnen, 1996 ; Scharner et al., 2002 ) where the presence of completely distended small intestinal loops was highly related to a definitive diagnosis
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