Is it critical?

Critical cases are defined as those where the horse requires hospitalisation for intensive medical management or surgical treatment, or was euthanased or died. This definition was used to identify cases where a rapid diagnosis can have a major impact on welfare.

Signs of severe pain

Cardiovascular changes

Alimentary system

These signs may occur alone or in combination and will vary between different cases. Recommendations are based on outcomes from a workshop process and from two studies that evaluated which aspects of initial case presentation were associated with critical outcomes.

Both a prospective study of 1016 cases and a retrospective study of 941 cases found that the most predictive model for a critical case on the primary presentation was based on a combination of factors: heart rate, mucus membranes, pain, and absence of gut sounds in one or more quadrants. This information was presented to a multidisciplinary workshop to generate recommendations, and then voted on by vets with experience of colic. The statements with the highest consensus for each sign are listed above, with those with highest ranking listed first.

Sources of evidence

Prospective study of the primary evaluation of 1016 horses with clinical signs of abdominal pain by veterinary practitioners, and the differentiation of critical and non-critical cases.

There is no level 1 or 2 evidence on the primary assessment of colic in the horse. The recommendations are based on outcomes of multi-disciplinary workshops and surveys of owners and veterinary practitioners with experience of colic. Statements were voted on by vets with experience of colic, accepted if >75% agreement on statements.

Critical cases 1 - printable

Critical cases 2 - printable