VetReact has been established from an equine research group at the School of Veterinary Medicine and Science, University of Nottingham exploring equine veterinary emergencies. The aim is to publish resources on common emergency conditions seen in equine practice, using Evidence Based Veterinary Medicine, to address the gaps in knowledge in this area of research. The current research being explored is into the primary evaluation diagnosis of colic and the differentiation of critical cases (those requiring hospitalisation, surgery or intense medical management). Resources have been developed for the use by veterinary practitioners and owners on equine colic. Emergency wound management is the next topic to be studied and research is currently being undertaken to develop similar resources in the future.


The project has had a number of phases: firstly identifying where there gaps in knowledge and evidence, secondly generating new evidence to address some of the gaps, thirdly determining how the evidence should be turned into practical recommendations, and fourthly developing methods of making the evidence accessible to owners and vets.


Identifying knowledge gaps

The first phase of the project reviewed some of the current evidence on colic, through systematic review of research studies relating to risk factors for colic, and of research studies on diagnostic tests for differentiating surgical / critical cases. This phase also included surveys on how horse owners recognise and respond to horses with colic to determine their understanding, knowledge and concerns about colic.


Generating new evidence

The reviews identified a lack of evidence from primary practice, with most of the information weighted towards referral hospitals and later assessments of cases. Three studies were conducted to generate more information in this area: a prospective study of the primary assessment and outcomes of horses presenting with colic, a questionnaire of how vets use different diagnostic tests, and a retrospective study of the primary presentation and outcomes of horses seen out of hours with signs of colic.


Translating evidence into recommendations

The third phase of the work involved translating evidence into recommendations. The lack of evidence meant that expert opinion and interpretation of how study outcomes could be applied in practice was required. This was done through a process which involved holding workshops with horse owners with experience of colic, vets with a range of different experience, and organisations involved in equine welfare, to work on specific areas and generate recommendations. These recommendations were then circulated a larger group of horse owners and vets who voted on whether they agreed with the recommendations.


Importance

Colic, the umbrella term for the clinical sign of abdominal pain, is the most common equine emergency condition seen in equine practice. Cases that are critical in nature (those requiring hospitalisation, surgery or intense medical management), with more severe underlying disease, can cause severe detriment to equine welfare, owner emotional and financial factors.


Time is a vital factor in the progression and prognosis of the small percentage of cases that are critical. Owners and veterinary practitioners need to be aware of the signs to reduce the preventable deterioration of signs that may be seen if an early diagnosis is not correctly made. With early decisions, the best welfare outcomes may be achieved for the horse. Owners and veterinary practitioners need to work together to recognise, diagnose and treat colic as quickly as possible, especially in crtical cases.


Currently, there is limited evidence into the primary assessment of colic or approaches used for 'in field' situations. Systematic reviews have analysed the available literature on risk factors and diagnostic tests, many of which are not applicable to ambulatory practice on the basis of evidence and study design. The majority of evidence available is related to hospital-based practice.


The Nottingham Colic Project is undertaking research to address some of the gaps acknowledged in the current available body of evidence. The research so far aimed to:



Researchers

 

Academic staff


Postgraduate students


Veterinary students


Logo design and artwork by Izzy Wild


We are also extremely grateful to the following organisations who were instrumental in this project. Our work with the BHS lead to the launch of the REACT to beat colic campgaign targeted at horse owners. The Petplan Charitable Trust supported the prospective study on the primary assessment of colic cases. World Horse Welfare supported the multi-disciplinary workshops and consensus studies, and the development of materials for veterinary practitioners.



Consensus process


Evidence

Recommendations


Use of Evidence-based Veterinary Medicine in Practice


In our project we wanted to explore how veterinary practitioners currently use evidence in practice. There have been no studies conducted into the different methods of knowledge transfer in equine veterinary practice, the barriers faced and importance of using evidence in approach to cases. Much of the available knowledge in equine practice is based on expert opinion and clinical experience, especially in primary practice. Using evidence in practice is widely used in human medicine, and more commonly used in small animal practice.


The Centre of Evidence-based Veterinary Medicine (CEVM), based at University of Nottingham provide evidence to be used in practice by veterinary practitioners, with a focus on small and large animal evidence. We have collaborated with them to develop evidence specifically for veterinary practitioners involved in equine work (through equine specific or mixed practice).


Understanding what equine practitioners currently use, barriers and preferences is useful to us in developing resources and should also be useful to be applied to future projects.