Received: 18 January 2021 Revised: 24 June 2021 Accepted: 30 June 2021

DOI: 10.1111/vec.13229

ORIGINAL STUDY

Epidemiology of severe trauma in cats: An ACVECC VetCOT

registry study

Jack A. Lee DVM1 Chien-Min Huang2 Kelly E. Hall DVM, MS, DACVECC3

1
Department of Small Animal Clinical Sciences,
University of Tennessee College of Veterinary Abstract
Medicine, Knoxville, Tennessee, USA
Objectives: To identify demographic information, epidemiological factors, and clinical
2
Franklin A. Graybill Statistical Laboratory,
Colorado State University, Fort Collins,
abnormalities that differentiate cats with severe trauma, defined as an Animal Trauma
Colorado, USA Triage Score (ATTS) ≥3 from those with mild injury (ATTS 0–2).
3
Critical Care Services, Department of Clinical Design: Multicenter observational study utilizing data from the American College of
Sciences, Colorado State University College of
Veterinary Medicine and Biomedical Sciences, Veterinary Emergency and Critical Care (ACVECC) Veterinary Committee on Trauma
Fort Collins, Colorado, USA (VetCOT) registry.
Setting: ACVECC VetCOT Veterinary Trauma Centers.
Correspondence
Kelly Hall, Colorado State University Animals: A total of 3859 cats with trauma entered into the ACVECC VetCOT registry
Veterinary Teaching Hospital, 300 W Drake
between April 1, 2017 and December 31, 2019.
Rd, Fort Collins, CO 80523, USA.
Email: [email protected] Interventions: None
Measurements and Main Results: Cats were categorized by ATTS 0–2 (mild, 65.1%)
Funding information
National Institutes of Health’s National Center and ≥3 (severe, 34.9%). There was no age difference between categories. Male animals,
for Advancing Translational Sciences, particularly intact animals, were overrepresented. Blunt trauma was more common
Grant/Award Number: UL1TR002494
than penetrating, with blunt trauma and a combination of blunt and penetrating trauma
being more common in the severe trauma group. While 96.6% of cats with ATTS 0–
2 survived to discharge, only 58.5% with ATTS ≥3 survived. Only 46.8% of cats with
severe trauma had a point-of-care ultrasound performed, of which 8.9% had free
abdominal fluid noted. Hospitalization and surgical procedures were more common in
the severe trauma group. Transfusions occurred more frequently in the severe trauma
group but only in 4.1% of these cats. Other than ionized calcium, all recorded clin-
icopathological data (plasma lactate, base excess, PCV, total plasma protein, blood
glucose) differed between groups.
Conclusion: Feline trauma patients with an ATTS ≥3 commonly present to Veterinary
Trauma Centers and have decreased survival to discharge compared to patients with
ATTS 0–2. Differences exist between these groups, including an increased frequency
of blunt force trauma (particularly vehicular trauma), head and spinal trauma, and cer-
tain clinicopathological changes in the ATTS ≥3 population. Relatively low incidences
of point-of-care ultrasound evaluation and transfusions merit further investigation.

Abbreviations: ATTS, Animal Trauma Triage Score; iCa, ionized calcium; POCUS, point-of-care ultrasound; TPP, total plasma protein; VetCOT, Veterinary Committee on Trauma; VTC, Veterinary
Trauma Center.

© Veterinary Emergency and Critical Care Society 2022.

J Vet Emerg Crit Care. 2022;32:705–713. wileyonlinelibrary.com/journal/vec 705

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706 LEE ET AL .

KEYWORDS
blood transfusion, feline, illness severity score, ultrasound

1 INTRODUCTION 2 METHODS

Significant strides have been made in better understanding the causes This was a multicenter observational study using data entered into the
and outcomes of trauma a in cats; however, few studies have looked at ACVECC VetCOT registry. Data in the registry comprise cases input by
its epidemiology in a large population, particularly in North America.1–4 a network of Veterinary Trauma Centers (VTCs) located in the United
Even less is known about the epidemiology, clinicopathological abnor- States, Canada, and the United Kingdom.23 The VTC network con-
malities, and outcomes of severe feline trauma cases. This lack of sists of both university and private hospitals, and data are recorded
information continues to limit understanding of potential preventa- on patients presenting for injuries associated with an external force,
tive steps. Gaining a better understanding may be an important step including blunt, penetrating, and crush injuries. The registry method-
in improving outcomes, ensuring required resources are appropri- ology, including variables collected, has been previously described.23
ately allocated, and providing more accurate prognostic information Data entered into the trauma registry are deidentified, and only
regarding trauma in this population. data generated via clinician-directed care are included. Variables that
Previous studies have consistently found traumatized cats to be require funds to perform (eg, biochemical data and diagnostics) are
young, with male and intact animals overrepresented.1–7 Trauma considered optional data, and missing variables may result either
is a common cause of mortality in cats and, in some countries, has because the test is not performed or not entered into the registry by
been documented as the leading cause of death in the primary care VTC data entry personnel.
setting.1–3,8,9 Mortality rates in the literature vary greatly with type An application for use of the VetCOT registry data was submitted
and severity of trauma.1,2,10–12 The severity of trauma can be quan- to and approved by the VetCOT registry subcommittee. Data were
tified using several scoring systems, including the Animal Trauma extracted for feline patients presenting to VTCs between April 1,
Triage Score (ATTS) and modified Glasgow Coma Scale.8,13,14 The 2017 and December 31, 2019. Although data are available as early as
ATTS has been shown to relate with mortality from various forms September 2013, for purposes of quality control and additional data
of trauma in smaller single-center studies in cats.6,7,10,17 Recently, capture, there were multiple changes to the registry questions on April
the ATTS has also been validated in a large multicenter population 1, 2017. As such, only data captured on or after April 1, 2017 were
using the American College of Veterinary Emergency and Criti- included in this analysis. Cases were divided by ATTS as either low
cal Care (ACVECC) Veterinary Committee on Trauma (VetCOT) (ATTS of 0, 1, or 2) or high (≥3), with the high score group defined
registry.8 as severe trauma. Cats without an ATTS recorded were excluded. Any
From this recent study,8 unpublished Youden’s J statistic suggests patient with body weight listed as 0 or of unknown sex was excluded
that an ATTS of 3.5 is the optimal cut point for predicting mortality.a from analysis in that category, but the remainder of the case informa-
A smaller, unpublished analysis of 112 cats from the University of Min- tion was retained for analysis. The registry was screened for possible
nesota evaluating ATTS versus survival to discharge using Youden’s data input errors reflecting biologically implausible results (eg, impos-
J indicated a cut point of 2.862 for prediction of in-hospital mortality sible negative number, or ionized calcium [iCa] >3 mmol/L [12 mg/dl]),
(P < 0.0001).b In human studies, severe trauma is defined as a mor- which were excluded.
tality risk >10% based on initial severity scores.18–21 Based on these Statistical analysis was performed using commercially available
results, we posit that an ATTS ≥3 is consistent with severe trauma software.c For each categorical variable, a chi-square test was used to
in cats. compare between trauma groups (mild vs severe). Counts and propor-
The primary goal of this study was to identify demographic infor- tions were also generated. Visual inspection of the data was used to
mation and describe epidemiological factors and clinical abnormalities assess normality and check for outliers. For each numeric variable, the
that differentiate cats with severe trauma, defined as an ATTS ≥3, Wilcoxon rank-sum test was used to compare between trauma groups
from those with mild injury (ATTS 0–2). We hypothesized that cats (mild vs severe). A nonparametric test was used because variables
with an ATTS ≥3 would have higher mortality than those with an showed evidence of skew and outliers. Summary statistics reporting
ATTS of 0–2, along with increased lactate, decreased base excess, median, Q1, Q3, and interquartile range (IQR) were reported. Statis-
decreased PCV and total plasma protein (TPP), and increased mor- tical significance was set at P < 0.05. Tables and figures were created
bidity, as demonstrated by increased rates of hospitalization and using commercially available statistical software.d,e Post hoc mortality
transfusion requirements. We also hypothesized that severely trau- by individual ATTS was assessed to determine which corresponded to
matized cats would be more likely to have suffered head and spinal >10% mortality in this registry. Youden’s J was calculated to determine
injuries. the optimal ATTS cut point for predicting mortality.
 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LEE ET AL . 707

TA B L E 1 Sex, outcomes, reasons for euthanasia, and type of trauma of 3859 cats sustaining trauma included in the American College of
Veterinary Emergency and Critical Care Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by
Animal Trauma Triage Score (ATTS) of 0–2 versus ≥3

ATTS 0–2 ATTS ≥3 Cases with data

Variable Response Frequency (%) Frequency (%) P-value input (%)
Sex FI 225 (9) 162 (12.7) <0.0001 3764 (97.5)
FN 826 (33.2) 411 (32.3)
MN 1168 (46.9) 526 (31.4)
MI 273 (11) 173 (13.6)
Outcome category Euthanized or died 85 (3.4) 556 (41.5) <0.0001* 3843 (99.6)
Survived to hospital discharge 2417 (96.6) 785 (58.5)
Reason for euthanasia Grave prognosis 30 (38.4) 248 (48.3) <0.0001 592 (92.4)
Financial limitations 23 (29.5) 77 (15)
Both 21 (26.9) 183 (35.6)
Type of trauma Blunt 1370 (54.6) 848 (62.9) <0.0001 3859 (100)
Both blunt and penetrating 112 (4.5) 176 (13.1)
Penetrating 1029 (41) 324 (24)

Note: Because not all patients had all data reported, percentages do not always summate to 100%.
Abbreviations: FI, female intact; FN, female neutered; MI, male intact; MN, male neutered.

3 RESULTS median ATTS among this group of 1 (IQR, 1). One thousand three hun-
dred and forty-eight cats (34.9%) had a high ATTS (≥3), with a median
3.1 Demographic information ATTS of 5 (IQR, 3) in this group. Outcomes and reasons for euthana-
sia by trauma score group are listed in Table 1. Survival to discharge
The registry contained 3883 cases of trauma in cats during the was lower in the high ATTS group (P < 0.0001). Patients in this group
time period of interest. Cats without an ATTS recorded (n = 24) were also more likely to be euthanized due to grave prognosis or both
were excluded, leaving 3859 cases for analysis (99.4%). Cats with an prognosis and financial limitation (P < 0.0001). An ATTS of 2 corre-
unknown sex (n = 95) and body weight of 0 (n = 81) were excluded sponded with a mortality of 6.9%, while an ATTS of 3 corresponded
from analysis of the respective variable. Review of 36 cases with an iCa with a mortality of 15.8%. Using Youden’s index, an ATTS cut point of 4
between 2.6 and 5.9 listed revealed that a single center had reported was selected as the optimal cut point for predicting mortality (sensitiv-
iCa in mg/dl. These values (n = 36) were multiplied by a conversion ity = 0.77, specificity = 0.86, Youden’s index = 0.63). But we note that
factor of 0.2495 to convert to mmol/L and retained for analysis. The a cut point of 3 performs similarly (sensitivity = 0.87, specificity = 0.75,
first and second authors remained blinded to which center these cases Youden’s index = 0.62).
came from. There were 2511 cats with a low ATTS (0, 1, or 2) and 1348
cats with a high ATTS retained for analysis.
In both groups, the most common breed represented was the 3.3 Types of trauma
domestic shorthair (75% vs 76%, respectively), followed by domestic
longhairs (8% vs 9%) and domestic medium hairs (5 vs 6%). Purebred In this trauma population, blunt injury (n = 2218, 57.4%) was the most
cats comprised 12% and 9%, respectively, with no purebred compris- prevalent inciting cause, with 35.1% (n = 1353) having penetrating
ing more that 2% of cases. Cats in both groups were young, with a injury, and 7.5% (n = 288) having both penetrating and blunt injury. Cats
median age of 3 years in both the low ATTS group (IQR, 7) and high in the higher severity group had a higher frequency of blunt trauma
ATTS group (IQR, 6.2), and no difference between groups (P = 0.255). and the combination of both blunt and penetrating trauma, while pene-
Median weight in the low ATTS group was 4.5 kg (IQR, 2.1). Median trating trauma alone was less common. This difference in distribution
weight in the high ATTS group was lower at 4.2 kg (IQR, 2; P < 0.001). was significant (P < 0.0001). These data are summarized in Table 1.
There was a difference in distribution of sex category between ATTS Causes of trauma are summarized in Figures 1 and 2. In cases of blunt
groups, with neutered male cats more common in the low ATTS group trauma, a fall from a height (24.0%), being struck by a vehicle (21.3%),
(P < 0.0001; Table 1). and nonpenetrating bite wounds (7.6%) represented the most common
classified causes. However, 22.6% had an unknown cause for the trau-
3.2 ATTS and mortality matic injury (ie, unobserved injury or animal return to caretaker injured
after being missing), and 18.4% did not fall into one of the specified
The median ATTS among all cats was 2 (IQR, 2). Two thousand five categories. Unknown trauma was more common in the lower severity
hundred and eleven cats (65.1%) had a low ATTS (0, 1, or 2), with a score group (ATTS 0–2), as was falling from a height. In those with ATTS
 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
708 LEE ET AL .

F I G U R E 1 Type of blunt trauma of 2506 cats sustaining trauma included in the American College of Veterinary Emergency and Critical Care
Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by Animal Trauma Triage Score (ATTS) of 0–2
versus ≥3

F I G U R E 2 Type of penetrating trauma of 1641 cats sustaining trauma included in the American College of Veterinary Emergency and Critical
Care Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by Animal Trauma Triage Score (ATTS) of
0–2 versus ≥3
 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LEE ET AL . 709

TA B L E 2 Clinicopathological data of cats sustaining trauma included in the American College of Veterinary Emergency and Critical Care
Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by Animal Trauma Triage Score (ATTS) of 0–2
versus ≥3

ATTS 0–2 ATTS ≥3 Cases with data

Variable n Median (Q1–Q3) n Median P-value input (%)
Blood lactate 441 1.7 (1.2–2.5) 541 2.3 (1.5–3.7) <0.0001* 982 (16.7)
concentration (mmol/L)
Base excess (mmol/L) 346 –5.5 (–7 to –4.1) 441 –6.1 (–8.6 to –4.2) <0.0001* 787 (13.4)
Ionized calcium (mmol/L) 410 1.26 (1.2–1.32) 482 1.25 (1.19–1.3) 0.0557 892 (15.2)
PCV (%) 667 37.5 (33–43) 643 36 (30–42) 0.0043* 1310 (22.4)
Total plasma protein in 647 72 (66–79) [7.2 (6.6–7.9)] 617 68 (60–75) [6.8 (6–7.5)] <0.0001* 1264 (21.57)
(g/L) [g/dl]
Blood glucose in (mmol/L) 681 8.3 (6.5–10.4) [149.4 (118–189)] 681 9.8 (7.6–12.7) [178 (138–232)] <0.0001* 1362 (23.3)
[mg/dl]
Abdominal fluid score 474 0 (0–0) 570 0 (0–0) 0.0043* 1044 (17.8)

TA B L E 3 Thoracic and abdominal POCUS findings of cats sustaining trauma included in the American College of Veterinary Emergency and
Critical Care Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by Animal Trauma Triage Score of
0–2 versus ≥3

ATTS 0–2 ATTS ≥3 Cases with data

Variable Frequency (%) Frequency (%) P-value input (%)
Abdominal POCUS exam performed 476 (20.9) 572 (46.8) <0.0001* 3503 (90.8%)
Thoracic POCUS exam performed 427 (18.8) 547 (44.9) <0.0001* 3494 (90.5%)
Pleural effusion identified 14 (3.3) 34 (6.2) 0.05 972 (25.2%)
Loss of glide sign identified 13 (3) 63 (11.5) <0.0001* 967 (25.1%)

Abbreviation: POCUS, point-of-care ultrasound.

≥3, being struck by a vehicle (35.9%) was far more common. In cases of ultrasound (POCUS, termed AFAST and TFAST in the registry) being
penetrating trauma, the most common cause was bite wounds (43.9%) performed (Table 3). In the abdomen, free fluid was also more common
followed by an unknown cause of the penetrating injury, then caused in this group, and higher abdominal fluid scores (>2 sites) were more
by one of the specified categories, then lacerations from metal (5.9%) common (Table 4). Pleural effusion was not more common in the higher
and laceration from glass (2.2%). Bite wounds were the most common ATTS group (P = 0.05); however, evidence of a pneumothorax (loss of
cause of penetrating trauma in both ATTS severity groups. glide sign) was more common (Table 3).
Head and spinal injuries were much more prevalent in the higher
trauma score group. These data are summarized in Table 5. Overall,
3.4 Clinicopathological abnormalities 32.7% of cats were hospitalized due to the severity of injuries. Cats
with severe trauma were hospitalized more frequently (46% vs 25.6%).
PCV, TPP, and base excess were lower in the high ATTS group than the In cats with ATTS 0–2, 0.28% of cases received a blood transfusion. All
low ATTS group. Conversely, plasma lactate concentration and blood of these received a packed RBC transfusion. In those with ATTS ≥3,
glucose were higher in the severe trauma than the mild trauma group. 4.10% received a transfusion. Of these, 78.1% received packed RBC
There was no difference between iCa levels. Laboratory data were transfusion, 20% received plasma, 12.7% received whole blood, and
available from less than 25% of cases, though this was higher in the high 3.6% received product that did not fall under the defined categories
ATTS group (Table 2). (“other”).
While there was no difference in frequency of surgical procedures
overall, the distribution of where surgery was performed did dif-
3.5 Additional morbidities fer. Surgery in the emergency room was more frequent in the lower
trauma score group and surgery in an operating room or another
Cats in the severe trauma group had a higher frequency of abdom- veterinary clinic more common in the higher trauma score group
inal (46.8% vs 20.9%) and thoracic (44.9% vs 18.8%) point-of-care (Table 6).
 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
710 LEE ET AL .

TA B L E 4 Abdominal POCUS fluid score of 1044 cats sustaining trauma included in the American College of Veterinary Emergency and Critical
Care Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019 that had an abdominal POCUS performed, divided
by ATTS of 0–2 versus ≥3

ATTS 0–2 ATTS ≥3 Cases with data

Variable Response Frequency (%) Frequency (%) P-value input (%)
Abdominal fluid score 0 454 (95.4) 521 (91.1) 0.0043* 1044 (27.05)
1 15 (3.2) 34 (5.9)
2 4 (0.8) 8 (1.4)
3 0 (0) 4 (0.7)
4 1 (0.2) 3 (0.5)

Note: A score of 0 indicates no free fluid, while a score of 4 indicates fluid at all 4 standardized sites.
Abbreviations: ATTS, Animal Trauma Triage Score; POCUS, point-of-care ultrasound.

TA B L E 5 Additional morbidities of cats sustaining trauma included in the American College of Veterinary Emergency and Critical Care
Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by ATTS of 0–2 versus ≥3

ATTS 0–2 ATTS ≥3 Cases with

Variable Frequency (%) Frequency (%) P-value data input (%)
Blood products administered 7 (0.28) 55 (4.1) <0.0001* 3844 (99.6%)
Admitted to hospital due to severity of injuries 642 (25.6) 620 (46) <0.0001* 3857 (99.9%)
Evidence of head injury 266 (10.6) 400 (29.7) <0.0001* 3859 (100%)
Evidence of spinal trauma 53 (2.1) 270 (20) <0.0001* 3859 (100%)

Abbreviation: ATTS, Animal Trauma Triage Score.

TA B L E 6 Surgical procedures performed on cats sustaining trauma included in the American College of Veterinary Emergency and Critical
Care Veterinary Committee on Trauma registry between April 1, 2017 and December 31, 2019, divided by ATTS of 0–2 versus ≥3

ATTS 0–2 ATTS ≥3 Cases with

Variable Frequency (%) Frequency (%) P-value data input (%)
Surgical procedure performed 819 (32.7) 442 (33) 0.91 3844 (99.6%)
In the emergency room 457 (55.8) 167 (37.8) 0.0229* 3859 (100%)
In the operating room 355 (43.3) 276 (62.4) <0.0001* 3859 (100%)
At other veterinary clinic 12 (1.5) 16 (3.6) 0.0229* 3859 (100%)

Note: For surgery location, percentages are based only on patients that had surgery performed. As some patients had surgery in multiple locations,
percentages may not summate to 100%.
Abbreviation: ATTS, Animal Trauma Triage Score.

4 DISCUSSION had a very similar Youden’s statistic, with improved sensitivity for pre-
dicting mortality, although with decreased specificity. This is higher
For this study, we proposed an ATT ≥3 to define severe trauma in cats. than in previous studies and may suggest improved outcomes in this
Definitions of major (severe) trauma in people include illness severity population. This trend should be followed over time.
scores with a >10% mortality rate.18–21 While very little has been pub- Cats sustaining severe traumatic injury comprise a large propor-
lished in cats, previous work in dogs has identified an ATTS cut point of tion of feline trauma patients presenting to VTCs and have markedly
5 as optimally predicting mortality.15,16 In cats, unpublished Youden’s worse outcomes than those less severely injured. In this population,
J analysis from a previous study using the VetCOT registry8 suggested approximately one third of cats were classified as severely injured, with
that an ATTS of 3.5 was the optimal cut point.a A smaller, unpublished a mortality rate of 41.5%, as opposed to a 3.4% mortality rate in the
analysis of 112 cats from the University of Minnesota evaluating ATTS low injury score group. A comparison of our results to the previously
versus survival to discharge using Youden’s J indicated a cut point of reported registry summary of cases from 2013 to 2017 showed overall
2.862.b In this study, an ATT of 3 corresponded with a >10% mor- survival to discharge for traumatized cats (83.3% in our study vs 82.5%)
tality risk, supportive of our dichotomy. Post hoc Youden’s J suggests remains similar.22 Given the high mortality rate, better understanding
that the optimal ATTS for predicting mortality was 4. An ATTS of 3 the features of this more severely injured population has the poten-
 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
LEE ET AL . 711

tial to improve outcomes. Early identification of feline patients with an medicine, euthanasia due to prognosis and cost of prolonged care also
ATTS ≥3 is important during the triage process, so that therapeutic and contributes to mortality. Understanding factors affecting euthanasia
diagnostic resources can be appropriately allocated to immediately and improving treatment of neurological injuries could significantly
identify and correct life-threatening injuries. improve outcomes.
Owing to the large size of the dataset, almost all variables exam- Both abdominal and thoracic POCUS were more likely to be per-
ined exhibited statistical differences between ATTS groups, although formed in the higher trauma score group, although only about half of
these differences may not all be clinically significant. Similar to pre- severe trauma cases were recorded as receiving one. The presence of
vious studies, the cats in this study were typically young, with intact free abdominal fluid was relatively uncommon in both trauma groups.
animals, particularly males, overrepresented.1–7 This was true in both When present, it was most commonly in only 1 site. As only the first
ATTS groups, with no difference in age between groups. Cats with a abdominal POCUS performed is input into the registry, it is possible
high ATTS trauma were 0.3 kg lighter than those with a low ATTS, these patients subsequently developed free fluid. One limitation of the
which may reflect the fact that smaller animals are more susceptible registry is that radiograph or advanced imaging findings are not noted,
to severe injury. Intact animals represented a higher proportion in the so it is possible that other imaging modalities were used. In veterinary
higher ATTS group. This may be due to greater time spent outside, medicine, POCUS has been best studied in dogs, where previous work
which can expose them to more opportunities for trauma, as well as showed a 27% incidence of free abdominal fluid after trauma, with half
delayed time between trauma and presentation to a veterinarian. How- of these patients having free fluid at >2 sites. Additionally, 15% of dogs
ever, housing status and where injuries occurred were not recorded in had a change in their fluid score on repeat exam.28 Another canine
this population. study showed an incidence of free fluid at 40% in vehicular trauma.29
In this study, blunt trauma was the most common cause of trauma A report on POCUS findings in cats with trauma has been published
reported, consistent with previous studies.1,2,4,22 Compared to 2013– in abstract form and found a 10% incidence of free abdominal fluid
2017, prevalence in the VetCOT registry of blunt trauma, penetrating on presentation, consistent with our findings.30 Incidence of thoracic
trauma, and a combination of both also remain similar (57.4% vs 56.7%, changes in cats has not been reported. Given that ultrasound has the
35.1% vs 39.1%, and 7.5% vs 4.2%, respectively).22 Vehicular trauma potential to identify numerous important sequelae of trauma, including
was a common cause of blunt trauma in this study, also consistent with pulmonary contusions, pneumothorax, hemothorax, uroabdomen, and
previous studies.2,4 Vehicular trauma has been previously associated hemoabdomen, POCUS is indicated in this population to help identify
with worse outcomes compared to other causes of trauma.2 Measures degree of injury during triage and resuscitation.31
that reduce exposure of cats to moving vehicles can therefore be one Several clinicopathological abnormalities were statistically different
way to reduce mortality. Interestingly, falling from a height represents between trauma groups. While PCV and TP were both significantly
a large proportion of cases in this registry, as previously reported in lower in the higher ATTS group, these differences are likely too small
the VetCOT registry summary.22 Such a high incidence has not been to be clinically useful. In spite of this small initial difference, the higher
reported in other papers, which have reported an incidence between trauma score group did have a higher incidence of RBC-containing
9.7% and 13.9%.2,4 As the VTCs have an urban skew, this may help to transfusions, suggesting that ongoing monitoring for progressive blood
explain this high incidence. Falling from a height was more likely in the loss is indicated in this population, particularly prior to anesthetic
low ATTS group. Previous work on high rise syndrome found a 96.5% events or procedures. Only a limited number of patients had labora-
survival rate, very similar to the low trauma group’s survival.23 The tory data entered into the database. Because laboratory testing and
severe trauma group had an 18.7% lower incidence of falls, but a 24.7% additional diagnostics are at clinician discretion and also depend on
higher incidence of being struck by a vehicle. owner finances, this may skew the cases where data are collected.
In cases of penetrating trauma, bite wounds were the most com- PCV was performed in only 47.7% of cases with a high ATTS; lac-
mon cause in both groups. This is consistent with previous studies.4,7 tate was performed in 40% of these cases. As bloodwork results can
The source of the bite wound (eg, other cat, dog, or wildlife) is not be input if collected within 24 hours, differences between pre- and
recorded in the registry. This represents an area for further study as it postresuscitation values, such as PCV/TPP, cannot be assessed. Clini-
could allow targeted client education on bite prevention. Higher ATTS copathological abnormalities in feline trauma have been examined in
was not associated with an increase in penetrating wounds, which may only a few papers. One single-center study looked at 43 cats with dog
reflect the fact that bite wounds are less likely to have greater systemic bite wounds and found increased lactate and decreased iCa in more
involvement, although this could differ on a case-by-case basis. The pri- severely affected cats.7 Ionized calcium did not differ between groups
mary difference between trauma categories was a higher incidence of in this study, which contrasts with previous studies that have found
ballistic injury in the higher ATTS score group, although these were still hypocalcemia to be a feature of critical illness, including trauma.4,7 The
rare. Mortality with gunshot injuries has previously been reported at reason for this discrepancy is not clear, but as most blood samples
13.5% and correlated with ATTS.17,24 are presumed to be collected near hospital admission, hypocalcemia
The higher ATTS group had a higher proportion of patients with may occur later during treatment. A prospective investigation of
head and spinal trauma. This is intuitive, given that one of the scor- clinicopathological abnormalities in feline trauma is needed.
ing categories for the ATTS is neurological function. Given the vital The low incidence of transfusion in this study population is unex-
structures involved, a higher mortality rate is expected. In veterinary pected. One study of pelvic trauma in cats found an 18.8% incidence
 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
712 LEE ET AL .

of transfusion, with requirement for transfusion positively correlating official views of the National Center for Research Resources or the
with ATTS.6 The previously reported registry data (from 2013 to 2017) NIH.
showed an incidence of 2.6%.22 To the authors’ knowledge, no other
literature on feline transfusion frequency in a trauma population has CONFLICT OF INTEREST
been produced. The low incidence in these patients contrasts with a Dr. Hall is the VetCOT and registry subcommittee chair and recused
36% incidence in 1 study of dogs hospitalized due to trauma.25 Given herself from the application process for VetCOT registry data use. The
the move toward resuscitation of hypovolemic human trauma patients other authors declare no conflict of interest.
with component blood products, better understanding resuscitation
practices for severely injured feline trauma patients is an important OFFPRINTS
next step.26,27 Given the lower frequency of free abdominal fluid in this Offprints will not be available.
study compared to what has been reported in dogs, it is possible that
hemorrhage is less common, but this requires further investigation. ORCID
Cats in the higher ATTS group had a higher frequency of surgical Jack A. Lee DVM https://orcid.org/0000-0002-5555-7215
procedures performed in an operating room. Given that bite wounds Kelly E. Hall DVM, MS, DACVECC https://orcid.org/0000-0001-
and lacerations were the most common cause of penetrating trauma 5399-932X
in both groups, wound repair may account for many of the proce-
dures performed in the emergency room. The registry does not record ENDNOTES
a
the type of procedure performed, but procedures such as laceration Hayes GM, Cornell University College of Veterinary Medicine, Ithaca, NY:
repairs might be expected to occur in the emergency room, while more Personal communication, 2019.
b
Hall K, University of Minnesota Feline Trauma Study, Minneapolis, MN:
major abdominal or thoracic radiographs might be expected to occur
Personal communication, 2013.
in operating rooms. Future work assessing factors such as injury distri- c
R Foundation for Statistical Computing, Vienna, Austria.
bution, damage control versus definitive surgery, and timing of surgery d
JMP Pro 15.0.0, SAS Institute Inc, Cary, NC.
e
could be helpful in guiding clinical decision-making. Excel for Mac 16.44, Microsoft Inc, Redmond, WA.

The limitations of this study include the potential for data input
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 14764431, 2022, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/vec.13229 by UNLP - Univ Nacional de La Plata, Wiley Online Library on [24/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
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