Elgin Orcum UZUNLU, Nuriza ZAMIRBEKOVA, Kurtulus PARLAK, Nuri YAVRU, Eyup Tolga AKYOL

Travmalı Köpeklerde Travma İçin Sonografi İle Odaklı Değerlendirme Protokolü ve Hayvan Travma Triyajı Skorlama Sisteminin Karşılaştırılması

FAST (travma için odaklanılmış sonografi) travmaya bağlı pnömotoraks, hemotoraks, hemoabdomen, idrar kesesi rupturu, organ hasarı gibi durumların değerlendirilmesi için geliştirilmiş bir ultrasonografi protokolüdür. Hızlı teşhis için travma hastasının sunumu sırasında uygulanır. Çalışmada travmatize olmuş köpeklerde ilk triyaj muayenelerinden FAST ve ATT (Animal Trauma Triage) skorlama sistemi sonuçları karşılaştırılarak, bu önemli triyaj muayene yöntemlerinin birbirlerini destekleyip desteklemediklerinin belirlenmesi amaçlanmaktadır. Çalışma materyalini; 2019-2020 yılları arasında Selçuk Üniversitesi Veteriner Fakültesi Cerrahi Kliniği’ne travma şikayeti ile getirilmiş farklı ırk, cinsiyet ve yaştaki 50 köpek oluşturdu. Travma sonrası üzerinden 24 saat geçmemiş köpekler çalışmaya dahil edildi. FAST ve ATT skorlama sistemi her bir hayvan için uygulandı. Travma geçiren 50 köpeğin ATT skorlaması 3 kategoriye ayrılarak değerlendirildi; 21 köpeğin ATT skoru iyi (0-5), 19 köpeğin ATT skoru orta (6-11) ve 10 köpeğin ATT skoru kötü (12-18) bulundu. 12 köpekte (%24) T-FAST muayenesinde toraks bölgesinde, 10 köpekte (%20) A-FAST muayenesinde abdominal bölgede anormal bulgular belirlendi. Spearman korelasyon analizi, travmalı köpeklerde ATT skoru ve A-FAST (r=0.04, P=0.75) ile ATT skoru ve T-FAST (r=0.140, P=0.33) arasında önemli bir ilişki olmadığını gösterdi. Sonuç olarak, travma geçiren köpeklerde ATT skoru ne olursa olsun, olası torasik veya abdominal patolojik durumların acil olarak saptanması için FAST uygulanması gerektiği sonucuna varıldı.

Comparison of the Focused Assessment with Sonography for Trauma Protocol and Animal Trauma Triage Scoring System in Traumatized Dogs

FAST (focused assessment with sonography for trauma) is an ultrasound protocol developed to assess conditions such as pneumothorax,hemothorax, hemoabdomen, bladder rupture, and organ damage due to trauma. It is performed at the time of presentation of a trauma patientfor rapid diagnosis. The aim of this study is to compare the results of FAST and ATT (Animal Trauma Triage) scoring system, which are among thefirst triage examinations, and to determine whether they support each other. Material of the study consisted of 50 dogs (diff erent breed, sexand age) presented in years between 2019-2020 to Selcuk University, Faculty of Veterinary Medicine, Department of Surgery Clinics with traumahistory within 24 h. FAST and ATT scoring system were performed for each dog. ATT score of 50 traumatized dogs was evaluated by dividinginto 3 categories; ATT scores of 21 dogs were good (0-5), 19 dogs were moderate (6-11), and 10 dogs were poor (12-18). Thoracic and abdominalabnormal findings were detected by T-FAST in 12 dogs (24%) and by A-FAST in 10 dogs (20%). Spearman correlation analysis showed there wasno significant association between ATT score and A-FAST (r=0.04, P=0.75), and ATT score and T-FAST (r=0.140, P=0.33) in traumatized dogs.In conclusion, FAST should be performed for urgent diagnosis of possible thoracic or abdominal pathological findings in traumatized dogs,regardless of ATT score.

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1. Jehle D, Davis E, Evans T, Harchelroad F, Martin M, Zaiser K, Lucid J: Emergency department sonography by emergency physicians. Am J Emerg Med, 7 (6): 605-611, 1989. DOI: 10.1016/0735-6757(89)90283-0
2. Savatmongkorngul S, Wongwaisayawan S, Kaewlai R: Focused assessment with sonography for trauma: Current perspectives. Open Access Emerg Med, 9, 57-62, 2017. DOI: 10.2147/OAEM.S120145
3. Valentino M, Ansaloni L, Catena F, Pavlica P, Pinna AD, Barozzi L: Contrast-enhanced ultrasonography in blunt abdominal trauma: Considerations after 5 years of experience. Radiol Med, 114 (7): 1080-1093, 2009. DOI: 10.1007/s11547-009-0444-0
4. Matsushima K, Frankel HL: Beyond focused assessment with sonography for trauma: Ultrasound creep in the trauma resuscitation area and beyond. Curr Opin Crit Care, 17 (6): 606-612, 2011. DOI: 10.1097/ MCC.0b013e32834be582
5. Boysen SR, Rozanski EA, Tidwell AS, Holm JL, Shaw SP, Rush JE: Evaluation of a focused assessment with sonography for trauma protocol to detect free abdominal fluid in dogs involved in motor vehicle accidents. J Am Vet Med Assoc, 225 (8): 1198-1204, 2004. DOI: 10.2460/ javma.2004.225.1198
6. Lisciandro GR, Lagutchik MS, Mann KA, Fosgate GT, Tiller EG, Cabano NR, Bauer LD, Book BP, Howard PK: Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma. J Vet Emerg Crit Care, 19 (5): 426-437, 2009. DOI: 10.1111/j.1476- 4431.2009.00459.x
7. Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, Albaladejo P, Ferretti GR, Bosson JL, Payen JF: Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest, 141 (5): 1177-1183, 2012. DOI: 10.1378/chest.11-0208
8. Salen PN, Melanson SW, Heller MB: The focused abdominal sonography for trauma (FAST) examination: Considerations and recommendations for training physicians in the use of a new clinical tool. Acad Emerg Med, 7 (2): 162-168, 2000. DOI: 10.1111/j.1553-2712.2000.tb00521.x
9. Tumbarello C: Ultrasound evaluation of abdominal trauma in the emergency department. J Trauma Nurs, 5 (3): 67-72, 1998. DOI: 10.1097/ 00043860-199807000-00003
10. Lisciandro GR: The use of the diaphragmatico-hepatic (DH) views of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) examinations for the detection of pericardial effusion in 24 dogs (2011-2012). J Vet Emerg Crit Care, 26 (1): 125-131, 2016. DOI: 10.1111/vec.12374
11. Walters AM, O’Brien MA, Selmic LE, Hartman S, McMichael M, O’Brien RT: Evaluation of the agreement between focused assessment with sonography for trauma (AFAST/TFAST) and computed tomography in dogs and cats with recent trauma. J Vet Emerg Crit Care, 28 (5): 429-435, 2018. DOI: 10.1111/vec.12732
12. Hoffberg JE, Koenigshof AM, Guiot LP: Retrospective evaluation of concurrent intra-abdominal injuries in dogs with traumatic pelvic fractures: 83 cases (2008-2013). J Vet Emerg Crit Care, 26 (2): 288-294, 2016. DOI: 10.1111/vec.12430
13. Milley E, Boysen S, Stillion J: A general practitioner’s guide to fast cageside ultrasound techniques. Companion Anim, 22 (7): 388-393, 2017. DOI: 10.12968/coan.2017.22.7.388
14. Lisciandro GR, Fosgate GT, Fulton RM: Frequency and number of ultrasound lung rockets (B-lines) using a regionally based lung ultrasound examination named vet blue (veterinary bedside lung ultrasound exam) in dogs with radiographically normal lung findings. Vet Radiol Ultrasound, 55 (3): 315-322, 2014. DOI: 10.1111/vru.12122
15. Fletcher S: Fast scans: What do RVNs need to know? Vet Nurs J, 32 (6): 161-164, 2017. DOI: 10.1080/17415349.2017.1308811
16. Lisciandro GR: Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals. J Vet Emerg Crit Care, 21 (2): 104-122, 2011. DOI: 10.1111/j.1476-4431.2011.00626.x
17. Rockar RA, Drobatz KS, Shofer FS: Development of a scoring system for the veterinary trauma patient. J Vet Emerg Crit Care, 4 (2): 77-83, 1994. DOI: 10.1111/j.1476-4431.1994.tb00118.x
18. Streeter EM, Rozanski EA, De Laforcade-Buress A, Freeman LM, Rush JE: Evaluation of vehicular trauma in dogs: 239 cases (JanuaryDecember 2001). J Am Vet Med Assoc, 235 (4): 405-408, 2009. DOI: 10.2460/ javma.235.4.405
19. Nordenholz KE, Rubin MA, Gularte GG, Liang HK: Ultrasound in the evaluation and management of blunt abdominal trauma. Ann Emerg Med, 29 (3): 357-366, 1997. DOI: 10.1016/S0196-0644(97)70348-2
20. Hayes G, Mathews K, Doig G, Kruth S, Boston S, Nykamp S, Poljak Z, Dewey C: The acute patient physiologic and laboratory evaluation (APPLE) score: A severity of illness stratification system for hospitalized dogs. J Vet Intern Med, 24 (5): 1034-1047, 2010. DOI: 10.1111/j.1939- 1676.2010.0552.x
21. Ash K, Hayes GM, Goggs R, Sumner JP: Performance evaluation and validation of the animal trauma triage score and modified glasgow coma scale with suggested category adjustment in dogs: A vetcot registry study. J Vet Emerg Crit Care, 28 (3): 192-200, 2018. DOI: 10.1111/vec.12717
22. Salci H, Cecen G, Gorgul OS, Akin İ: Multiple thoracic and thoracoabdominal trauma: Case report. Kafkas Univ Vet Fak Derg, 15 (3): 473-476, 2009. DOI : 10.9775/kvfd.2009.053-G
23. Salci H, Bayram AS, Celimli N, Caliskan GU, Gorgul OS, Kramer M: Evaluation of thoracic trauma in dogs and cats: A review of seventeen cases. Iran J Vet Res, 11 (4): 325-331, 2010.
24. Mcmurray J, Boysen S, Chalhoub S: Focused assessment with sonography in nontraumatized dogs and cats in the emergency and critical care setting. J Vet Emerg Crit Care, 26 (1): 64-73, 2016. DOI: 10.1111/ vec.12376
25. Simpson SA, Syring R, Otto CM: Severe blunt trauma in dogs: 235 cases (1997-2003). J Vet Emerg Crit Care, 19 (6): 588-602, 2009. DOI: 10.1111/j.1476-4431.2009.00468.x
26. Kolata RJ: Trauma in dogs and cats: An overview. Vet Clin North Am Small Anim Pract, 10 (3): 515-522, 1980. DOI: 10.1016/S0195- 5616(80)50051-3
27. Armenise A, Boysen RS, Rudloff E, Neri L, Spattini G, Storti E: Veterinary‐focused assessment with sonography for trauma‐airway, breathing, circulation, disability and exposure: A prospective observational study in 64 canine trauma patients. J Small Anim Pract, 60, 173-182, 2019. DOI: 10.1111/jsap.12968
28. Lisciandro GR, Lagutchik MS, Mann KA, Voges AK, Fosgate GT, Tiller EG, Cabano NR, Bauer LD, Book BP: Evaluation of a thoracic focused assessment with sonography for trauma (TFAST) protocol to detect pneumothorax and concurrent thoracic injury in 145 traumatized dogs. J Vet Emerg Crit Care, 18 (3): 258-269, 2008. DOI: 10.1111/j.1476- 4431.2008.00312.x
29. Hwang TS, Yoon YM, Jung DI, Yeon SC, Lee HC: Usefulness of transthoracic lung ultrasound for the diagnosis of mild pneumothorax. J Vet Sci, 19 (5): 660-666, 2018. DOI: 10.4142/jvs.2018.19.5.660
30. Holowaychuk MK, Monteith G: Ionized hypocalcemia as a prognostic indicator in dogs following trauma. J Vet Emerg Crit Care, 21 (5): 521–530, 2011. DOI: 10.1111/j.1476-4431.2011.00675.x