Prognosticating Mortality in Dogs with Blunt Trauma

In the Literature 

Poirier M, Stillion JR, Boysen SR. Markers of tissue perfusion and their relation to mortality in dogs with blunt trauma. J Vet Emerg Crit Care (San Antonio). 2023;33(1):16-21. doi:10.1111/vec.13249

The Research … 

Blunt force trauma is a common veterinary emergency, with vehicular trauma being the most common cause in dogs.^1,2  

This prospective, single-center study evaluated markers of tissue perfusion (eg, admission lactate, lactate clearance, admission base excess) and illness severity scoring systems (ie, Animal Trauma Triage [ATT] score, shock index [heart rate/systolic blood pressure]) to prognosticate survival following blunt trauma.    

Of 44 dogs hospitalized for blunt trauma (40 from motor vehicle accidents), 29 survived. Median age was 3 years, but a wide range (0.5-14 years) was represented. On presentation, acid–base status, electrolytes, injury severity scores, vital parameters, and an abdominal fluid score were obtained. Tissue perfusion markers (ie, acid–base status, pH, bicarbonate, base excess, admission plasma lactate) were the only parameters associated with survival. Abdominal fluid score, 4-hour lactate clearance, and shock index were not associated with outcome. Patients that did not survive had a higher ATT score, which correlates with increased severity of trauma.  

Although not demonstrated in this study, previous studies have shown base excess is an independent predictor of blood transfusion requirement in patients with blunt trauma and lactate clearance (not admission lactate) is a predictor of survival in dogs with shock.^3-5 

… The Takeaways

Key pearls to put into practice:

• Results of this study highlight the importance of abnormal perfusion markers following blunt trauma in dogs, as abnormal markers may lead to worse outcome and should be addressed promptly. Restoring tissue perfusion through prompt and calculated resuscitation is critical; however, because this was an observational study with a small population size, it is difficult to apply prognostic value to individual cases based solely on these findings.   

• Cats were not evaluated, but the importance of tissue perfusion and principles of resuscitation are similar across species. Results may therefore be relevant in feline patients with blunt trauma.  

• Increased ATT score and abnormal markers of tissue perfusion should raise concern for severity of injury and prompt careful patient assessment and monitoring. Discussion with pet owners regarding prognosis may be supported by these findings but should also be based on each patient’s diagnostic and physical examination trends.