Colic pain scale tested in study found to be feasible, reliable and easy to use

Rolling is one of the primary signs of severe colic.
Rolling is one of the primary signs of severe colic. Image by Alexas_Fotos

A scale to assess the level of pain in horses with colic has been put to the test in two equine hospitals, proving to be feasible, reliable, quick, and easy to use.

The Equine Acute Abdominal Pain Scale (EAAPS) was evaluated in 237 horses with abdominal discomfort. It was found to be suitable for use in such settings and performed as well as the Visual Analogue Scale (VAS), except at predicting mortality.

Yamit Maskato and her fellow researchers said the use of the EAAPS, first reported in 2013, apparently requires no training, is easy to use in clinical cases, and can improve equine welfare.

The study team, from the veterinary schools at The Hebrew University of Jerusalem and the University of Liverpool, said the EAAPS should now be tested in the field by veterinarians, as well as by horse riders, caretakers, and farm owners who lack medical training.

The authors, writing in the journal Animals, said colic is a common condition of horses characterised by abdominal pain and high mortality.

In 2015, it caused 31% of deaths in horses aged 1 to 20 years, making it the most common cause of equine death in the United States.

A horse demonstrating flehman, or lip curling, a common colic behaviour.
A horse demonstrating flehman, or lip curling, a common colic behaviour. Image by Céline Saillet

“Research and clinical experience have shown that severity of pain is an important parameter for clinical decision making, monitoring patient status, evaluating analgesia effectiveness, humane end-point decisions, as well as for research. However, pain assessment is subjective.”

The researchers noted that many attempts had been made to devise pain scoring systems in horses.

Among the pain scales based on behaviours, the Horse Grimace Scale and the equine facial expression pain scale require training.

The EAAPS utilises typical colic behaviours. In previous research, it delivered good to excellent agreement and minimal bias between equine veterinarians viewing films of horses with colic.

It is based on a simple descriptive scale shown in the table below. A simple one-digit score is given to grade the severity of pain based on descriptors to guide the choice of the score.

The Equine Acute Abdominal Pain Scale. A pain severity score is given based on the score of the behaviour demonstrated. If two or more behaviours are demonstrated, then the score is assigned based on the behaviour with the highest value. Image: Maskato et al.

The study was carried out at two institutions. Participants included veterinarians, technicians, and veterinary students at the Koret School of Veterinary Medicine Teaching Hospital in Israel and at the Philip Leverhulme Equine Hospital, part of the University of Liverpool.

Participants evaluated horses older than 1 year of age who presented with acute abdominal pain or colic. Pain severity was assessed by using both a global VAS and the EAAPS.

In all, pain in 231 horses presented for colic was assessed by 35 participants — 26 in England and 9 in Israel.

Participants generally reported the EAAPS to be quick and easy to use.

“More experienced first-time users found it significantly quicker to use than less experienced participants,” they noted.

Discussing their findings, the authors said the EAAPS was found to have two important qualities — feasibility and reliability.

“The feasibility was tested under real-life conditions when the horse demonstrating pain needed to be assessed quickly and easily to make rapid clinical decisions necessary in emergency situations.

“The fact that none of the assessors in this study received training in the use of the EAAPS prior to scoring the horses, and yet, no participants felt that it was very difficult or very slow to use, supports the claim that the EAAPS is very quick and easy to use.

“In conclusion,” they wrote, “the EAAPS is the only equine pain assessment scale that has been tested and found to demonstrate good feasibility for use in the referral hospital setting.”

The study team comprised Maskato, Gal Kelmer and Gila Sutton, all with the veterinary school at The Hebrew University of Jerusalem; and Alexandra Dugdale and Ellen Singer, with the veterinary school at the University of Liverpool.

Maskato, Y.; Dugdale, A.H.A.; Singer, E.R.; Kelmer, G.; Sutton, G.A. Prospective Feasibility and Revalidation of the Equine Acute Abdominal Pain Scale (EAAPS) in Clinical Cases of Colic in Horses. Animals 2020, 10, 2242.

The study, published under a Creative Commons License, can be read here

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