Three “red flags” in the most serious cases of colic stand out in study

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Three red flags significantly associated with the likelihood of a critical outcome in horses with colic are an increased heart rate, increasing age and abnormal mucous membrane colour. Photo by Eleventh Wave on Unsplash

It’s after-hours and you’ve just called the vet because of a horse that appears colicky. Are you over-reacting?

Evidence from a just-published British study suggests the owner has done the sensible thing.

The findings, reported in the journal Veterinary Record, highlight the significant death rate associated with colic, especially if certain “red flags” are involved.

Colic is the most common reason for emergency callouts for veterinarians, being responsible for a third of cases.

While colic cases are frequently resolved with simple medical management and pain relievers, a proportion prove critical.

Researchers in a University of Nottingham study set out to identify the indicators of critical outcomes in colicky horses seen after-hours by two major equine veterinary practices in England.

In all, the clinical notes from 941 colic cases were examined by Adelle Bowden and her colleagues.

They were categorised as either critical or not critical. A critical outcome was defined as requiring medical or surgical hospital treatment or resulting in euthanasia or death.

A non-critical case was defined as resolving with simple medical treatment.

The study team found that 225 of the cases — 23.9 percent — were critical.

Analysis of the data identified three red flags significantly associated with the likelihood of a critical outcome: an increased heart rate, increasing age and abnormal mucous membrane colour.

Overall, 168 of the horses, 18 percent of those in the study, were euthanised.

“The ‘red flag’ parameters identified should be considered an essential component of the primary assessment of horses with colic, and for this reason, an early, thorough assessment of the horse by a veterinary surgeon is of paramount importance,” the study team said.

Flank watching is a classic sign of colic.
Flank watching is a classic sign of colic. © University of Nottingham

The researchers said they found no obvious seasonality among the colics, and no consistent trends.

A change of demeanour was noted in a third of the case records, with some restless or agitated, while others were unusually dull or depressed.

Sixty-two percent of the horses required a single treatment to resolve their colic, while a further 18 percent needed multiple treatments.

Abdominal surgery was recommended in 7 percent of cases, and performed in 4 percent of cases. In all, 54 percent of the horses that underwent surgery (22 of 41 animals) survived to discharge.

Nineteen percent of the 941 horses did not survive their colic episode, with 18 percent euthanised and just under 1 percent dying.

The researchers say there is a need for further studies, especially in relation to first-opinion cases and the large number of colics with critical outcomes.

They say early recognition of critical cases is essential, regardless of whether euthanasia is the elected option, as colics represent a significant welfare concern.

The role of age in critical cases also needs further examination, they say, to determine whether this is because of older horses being more likely to have critical conditions, or that owners are more likely to choose euthanasia instead of treatment.

“The key finding from this study was the identification of key ‘red flag’ indicators for critical outcomes … and adds to the strength of evidence for these as critical indicators.

“These clinical parameters should be considered essential components of the assessment and monitoring of horses with acute abdominal pain.”

The full study team comprised Bowden, Gary England, Marnie Louise Brennan, Sarah Freeman and John Burford, all with the University of Nottingham; Tim Mair, with The Bell Equine Veterinary Clinic in Maidstone; and Wendy Furness, with the Scarsdale Equine Practice in Derby.

Indicators of ‘critical’ outcomes in 941 horses seen ‘out-of-hours’ for colic
Adelle Bowden, Gary C W England, Marnie Louise Brennan, Tim S Mair, Wendy A Furness, Sarah L Freeman, John H Burford.
Veterinary Record (2020) doi: 10.1136/vr.105881

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