Pain assessment in the dog: the Glasgow Pain Scale
Pain is an unpleasant personal emotional experience. It has 3 dimensions: Sensory – discriminative (location, intensity, quality, duration)...
Issue number 25.3 Other Scientific
Emergency visits to primary care veterinary hospitals
Published 15/04/2021
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This paper will present some basic epidemiology of dogs seen for emergency care at a network of primary veterinary clinics in the United States of America. The findings presented in this paper are only intended to provide a bird’s eye view of the common causes of emergency visits...
Introduction
This paper will present some basic epidemiology of dogs seen for emergency care at a network of primary veterinary clinics in the United States of America. The findings presented in this paper are only intended to provide a bird’s eye view of the common causes of emergency visits to most primary care veterinary practices, and the progress and clinical outcomes for each category are beyond the scope of this paper.
Methods of analysis
The health records of all dogs presented at Banfield Pet Hospital during 2014 were screened to identify those that came in as an “emergency” visit. To be included, a case had to meet at least one of the following criteria: the reason for the visit was recorded as “emergency”, the owner was invoiced for “emergency medical treatment” (e.g., emergency/urgent/after hours care), or there was a diagnosis of “hit-by-car” (HBC). A count of the diagnosis entered at each visit was made; from this list, any condition likely to be unrelated to the reason for the emergency visit (e.g., dental calculus, nuclear sclerosis) was removed, and a list of the top 10 “emergency diagnoses” created. These were then grouped into 10 categories: dermatologic conditions (e.g., abrasion/wound/trauma, abscess, bites); HBC or bone fracture; respiratory disease (e.g., bronchitis, tracheal collapse, asthma, coughing, dyspnea); toxin exposure (e.g., plant, chemical or other medicinal toxicity); allergic reaction (e.g., anaphylaxis, urticaria); neurologic disease (e.g., seizures, anisocoria, vestibular disease); gastrointestinal disease (e.g., vomiting, diarrhea, hepatic disorder, pancreatitis); endocrine/metabolic disease (e.g., diabetes mellitus, diabetic ketoacidosis, adrenal disorder); urogenital disease (e.g., dystocia, pyometra, eclampsia, kidney disease, urinary tract obstruction); or nonspecific (e.g., malaise, anorexia, fever). Co-occurrence of certain problems (bone fracture, skin wound, respiratory disease or neurologic disease) related to a hit-by-car diagnosis was also investigated.Results
Nearly 2.4 million dogs were seen in almost 7 million pet visits to Banfield Pet Hospital in 2014. This included 21,840 dogs (0.9%) seen for 22,625 “emergency” examinations, and of these, approximately 57.7% (13,056) of the visits had an exact diagnosis entered into the appropriate field of the health record. The top 10 breeds presented as an emergency are shown in Table 1; Chihuahuas and Labrador Retrievers were the most common breeds seen. Top diagnoses and the frequency of each diagnosis are shown in Tables 2a and b; HBC was the most common cause of an emergency, at 22.8% of all visits. Within the ten “emergency categories”, conditions within the “dermatologic” sector were most commonly encountered (25.4% of all cases), followed by the “HBC/bone fracture” category (24.5%). With regard to animals hit by a car, concurrent injuries were not uncommon, as shown in Table 3; for example 27.8% of dogs had related dermatologic wounds and 11.5% had bone fractures.
| Dogs | Number of unique pets seen | Percentage of emergency pets |
|---|---|---|
| Chihuahua | 2,114 | 9.7% |
| Labrador Retriever | 1,932 | 8.8% |
| Pit bull | 1,292 | 5.9% |
| Yorkshire Terrier | 1,247 | 5.7% |
| Shih Tzu | 1,060 | 4.9% |
| Dachshund | 795 | 3.6% |
| Mixed breed | 742 | 3.4% |
| German Shepherd | 720 | 3.3% |
| Boxer | 691 | 3.2% |
| Maltese | 676 | 3.1% |
* The list of the top affected breeds is very similar to their breed representation in the overall Banfield pet population seen during the course of the year.
| Specific diagnosis | Number of emergency visits with this diagnosis | % of emergency visits with diagnosis |
|---|---|---|
| HBC (hit by car) | 2,975 | 22.8% |
| Seizures | 1,362 | 10.4% |
| Poisoning/toxicity | 942 | 7.2% |
| Malaise | 836 | 6.4% |
| Laceration | 733 | 5.6% |
| Abrasion | 717 | 5.5% |
| Wound from animal bite | 590 | 4.5% |
| Allergic reaction** | 501 | 3.8% |
| Allergic reaction (acute)** | 406 | 3.1% |
| Hepatopathy | 356 | 2.7% |
** “Allergy” covers problems such as skin reactions whilst “acute allergy” was used for life-threatening or severe conditions.
| Diagnosis group | Number of emergency visits | % of emergency visits |
|---|---|---|
| Dermatologic problems | 3,322 | 25.4% |
| HBC/bone fracture | 3,197 | 24.5% |
| Gastrointestinal | 2,032 | 15.6% |
| Neurologic | 1,694 | 13.0% |
| Toxin/poison | 1,565 | 12.0% |
| Nonspecific | 1,117 | 8.6% |
| Allergy/allergic reaction | 1,077 | 8.3% |
| Respiratory | 660 | 5.1% |
| Urogenital | 319 | 2.4% |
| Endocrine/metabolic | 242 | 1.9% |
| Number of HBC cases*** | 2,453 |
| % with bone fracture | 11.5% |
| % with dermatologic wound | 27.8% |
| % with respiratory diagnosis | 3.8% |
| % with neurologic diagnosis | 1.9% |
*** Note that the number of HBC cases are slightly less than the number of HBC visits given in Table 2a; this is because some animals had more than one visit for a HBC incident.
Discussion
The list of diagnoses from emergency visits will not be a surprise to the general practice veterinarian. It is tempting to suspect there might be a breed predisposition to having an injury or condition resulting in an emergency visit, but this is unlikely as the list of the top affected breeds is very similar to their breed representation in the overall Banfield pet population seen during the course of the year. It is possible that HBC as the most common diagnosis was biased, as the definition of an “emergency visit” for this study included all pets involved in a vehicle incident, irrespective of whether or not the animal was deemed to require an “emergency” visit. In addition, there is potential bias because over 40% of the cases did not have an exact diagnosis entered in the appropriate field of the health record; however, a random review of these cases found that their actual problems could be categorized with frequencies similar to those cases where a diagnosis had been entered. It is therefore unlikely that HBC cases (and indeed the other diagnoses) in Tables 2a and b are either over- or under-represented, and it is therefore reasonable to assume that the percentages for the co-occurrence of certain conditions related to car accidents, as shown in Table 3, are fairly accurate.
Other articles in this issue
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Wound management 2 – Penetrating injuries in dogs
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