The Analysis of Caseloads of 24-Hour Emergency Medical Service in National Taiwan University Veterinary Hospital

Transcription

1 ijf~i!(u 1tj\; Taiwan Vet1 32 (4): , 2006 The Analysis of Caseloads of 24-Hour Emergency Medical Service in National Taiwan University Veterinary Hospital ' Shu-Fanq YANG, 'Chu-Mei LAI, 'Chen-l L1U, ' I-Chenq TSENG, 1Yi-Chih L1U, 1Chi-Ting HUANG, 2Heng-Leng YANG, 2Sao-Ling LIANG, 'Han-Ju TSAI, *1,3Tzong-Fu KUO *'National Taiwan University Veterinary Hospital, Taipei 706, Taiwan, R.O.C. 'Depertment of Veterinary Medicine, National Chiayi University, Chiayi 600, Taiwan, R.O.C. " Greduete Institute of Veterinary Medicine, National Taiwan University. No.7, Sec. 4, Roosevelt Rd., Taipei 706, Taiwan, R.O.C. (Received: February 27, Accepted: Angnst 24, 2006.) ABSTRACT 24-hour emergency medical service for small animals in National Taiwan University Veterinary Hospital (NTUVH) was opened in May 1, 2004, Emergency medical caseloads from May 1, 2004 to October, 2005 (18 month s) were analyzed, Total cases in the study are 5579 which include 4472 canine cases (80,2%), 979 feline cases (17.5%) and 128 other small animal cases including rabbits, mice, etc, (2,3%), Systemic categorization included 1356 gastroenterological cases (24.31%), 696 cardiovascular cases (12.48%), 664 traumatolog ical cases (11.90%), 432 uronephrological cases (7.74%), 350 respiratory system cases (6.27%), 298 inf ectious diseases cases (5.34%), 201 neurological cases(3.60%1. dead-on-arrival 193 cases (3,46%), 186 dermatological cases (3.33%), 145 tox icological cases (2.60%), 144 metabol ic and endocrinolog ical cases (2,58%), 123 musculoskeletal cases (2.20%), 120 theriogenolog ical cases (2,15%), 109 hematological cases (1.95%), 99 oncological cases (1,77%), 71 ophthalmo logic cases (1.27%), 69 environmental exposure cases (1.23%), 32 post-operative complication cases (0.57%) and 291 other unclassified diagnosis cases (4.6% After emergency medical treatment, out-patients were 3757 cases (67.3%), in-patient 1138 cases (20.4%), 351 mortal cases (9.5 %) and 153 transfer cases (2.7%). The emergency cases were 9.54% (5,579/58,478) of the total cases. With the results of this study, we can bette r prepare for emergency in the fut ure. [Yang SF, Lai CM, Liu CI, Tseng IC, Liu YC, Huang CT, Yang HL, Liang SL, Tsai HJ, *Kuo TF. The Analysis of Caseloads of24-hour Emergency Medical Service in National Taiwan University Veterinary Hospita l. Taiwan Vet J 32(4): , *Corresponding author TEL: I, FAX: , Key words: emergency medicine, small animals, NTUVH INTROD UCTION A 24-hour emergency med ical service for small animals at National Taiwan University Veterinary Hospital (NTUVH) was opened from May I, 2004 to October The emergency medical service provided care for critically ill patients who presented various diseases and traumas. The aim of this study is to ana lyze and investigate cases presented, times presented and the disease distri bution through species, breed, body systems, internal or external conditions and final outcomes. These analyses can provide information for

2 The Ana lysis of Caseloads of24-hour Emerge ncy Medical Service in National Taiwan 259 future clinical reference. MATERIALS AND METHODS All emergency case histories were collected between May 2004 and October The samples were analyzed including species, breed, sex, age, and admission time (from 8:00 am to 10:00 pm, and from 10:00 pm to 8:00 am). The systematic categori zation was ana lyzed [8] (including card iovasc ular, post-operation complications, dead-on-arrival, dermatology, enviro nmental exposure, gastroenterology, metabolic and endocri nology, hematology, infectious diseases, muscu loske letal, neuro logy, oncology, ophthalmology, reproductive, resp iratory, toxicology, trauma, uronephro logy, and other unclassified diagnosis diseases) and the final outcome of the emergency cases ( out-patient, in-patie nt, transfer to local veterinarian or surgery section, death) and the causes ofdeath. To diagnose and treat all presenting emergency cases, owner's observations and animal's history were recorded, physical examination by the attending veterinarian doctor was performed and, as required, the use of all NTUVH diagnostic facilities and equ ipment were employed. Age The age ofcanine patients ranged from 1 day to 22 years old with mean age of 6.4 years, and feline from I day to 19 years old with mean age of3.8 years. In dogs, the percentage of the age less than 1 year was 24.2%, range from 1 year to 8 years was 33.8%, and greater than 8 years was 42.0%. In cats, the percentage of the age less than I year was 34.4%, range from 1 year to 8 years was 50.6%, and greate r than 8 years was 15.0% (Fig.2). Sex 2,486 of the 4,472 dogs (55.6%) were male, 1,986 (44.4% ) were female. 547 of the 979 cats (55.9%) were male, 432 (44.1%) were female (Fig.3). Breed Dog One thousand one hundred eighteen ( II I 8; 25.0%) dogs seen were mixed-breeds, 868 ( 19.4% ) were Ma ltese, 416 (9.3%) were Pomeranian, 286 (6.4%) were Miniature Schna uzers, 259 (5.8%) were Yorkshire Terriers, 201 (4.5%) were Pood les, 183 (4.1% ) were Golden Retrievers, 161 (3.6%) were Beagles, 148 (3.3%) were Chihuahuas, 134 RESULTS Species Total emergency cases were 5579, including 4472 canine cases (80.2%), 979 feline cases ( 17.5% ) and 128 exotic species cases (2.3%). The exotic species included 57 (44.5%) rabbits, 35 (27.3%) hamsters and guinea pigs, 13 (10.2%) miniatu re pigs, 8 (6.3%) avian species, 4 (3. 1% ) ferrets and II (8.6%) others species ( Fig. I ). % Fig. 2 <=Iy l-sys age >Sys o dogs. cats The percent distribution by age in dogs and cats xn D Caninc: _ Fd in. D F.x o t k ~ ts % IOdOgl cat 211 male fema le II C.tr.ir:.:;: Feline sex Fig. 1 The percent distribution by species Fig. 3 The percent distribution by sex in dogs and cats

3 260 Shu-Fang YANG et at (3.0%) were Labrador Retrievers, and the rest, 698 ( 15.6% ), represented other breeds (FigA). Cat Five hundred ninety -three (593; 60.6%) cats seen were mix-breeds, 229 (23.4%) were Persians, 47 (4.8%) were American short hairs, 44 (4.5%) were Chinchillas, 26 (2.7%) were Siamese, and the rest, ( 40; 4.0% ), represented other breeds (Fig.5). Emer gency Ad mission Time The emerge ncy medica l center was open for 24 hours with two specific time periods: 8 a.m. to 10 p.m.; 10 p.m. to 8 a.m. Cases admitted from 8 a.m. to 10 p.m. were 3,431 ( 61.5%) ; from 10 p.m. to 8 a.m. were 2,147 ( 38.5% ) (Fig.6). The average emergency case load was 3.93 per day (3.93±2.28, ranged from 0 to 14 cases) at night. Disease diagno sis Systematic categorization of emergency medical case diagnoses included 1,356 gastroentero logical cases (24.3 1% ), 696 cardiovascular cases ( 12.48%), 664 trauma cases ( 11.90% ), 432 uronephrological cases (7.74%), 350 respiratory system cases (6.27%), 298 infectious disease cases (5.34%),201 neurological cases (3.60%), 193 dead-on-arrival cases (3.46%), 186 dermatological cases (3.33%), 145 toxico logica l cases (2.60% ), 144 metabo lic and endocrinological cases (2.58% ), 123 musculoskeletal cases (2.20%), 120 theriogenological cases (2.15%), 109 hematological cases ( 1.95% ), 99 onco logical cases ( 1.77% ), 71 ophthalmologic cases ( 1.27% ), 69 environmental expo sure cases ( 1.23% ), 32 post-operative complicatio ns cases (0.57%) and 291 other unclassified diagnosis cases ( 4.6% ) (Fig. 7 ). % Fig persian ASH Chinchila 0"----'-- - 1< '' amm:oo. pm I ();l10 pm I0 :00 am8:00 Siamese 25..~ , 2() l~ 30I 251.'c i 20I OL:L KI ~.., ~4-., ' \.J.,",. f>-~ 0t-,,:;l :1' "t-.... i~~,..$';"( ~-t'. q,,~ ~....~~ -c <\ lo: ;.f (5-... Fig. 4 The percent distribution by breed in dogs ( top 10 ) ( YT: Yorkshire Terriers; GR: Golden Retrievers; LR: Labrador Retrievers ) Fig. 5 The percent distribution by breed in cats ( top 5 ) ( ASH : American short hairs ) The percent distribution by admission time In gastroenterological cases ( 1356, 24.31% ), disease distribution revea led gastroenteritis 79.9%, hepatic failure 5.2%, gastri c or intestinal foreign body 3.6%, pancreatitis 2.3%, gastric dilatio n and volv ulus (GOY) 1.2%, constipation 1.0%, hemorrhagic gastroe nteritis ( HGE ) 1.0%, rectal prolapse 0.1%, and others GI problem 5.7%. In cardiovascular cases (696, 12.48%), disease distribution reveale d heart failure 61.6%, heartworm Fig. 7 The percent distribution by systematic categorization of emergenc y medicine cases.

4 The Analysis of Caseloads of24-hour Emergency Medical Service in Na tion al Taiwan 261 disease 9.1%, syncope 4.6%, con genit al heart disease 0.5%, arterial thromboembolism 0.4%, and others 23.8%. In trauma cases ( 664, 11.90%), disease distribution revealed that the animal was hit by a car ( HBC ) 43.4 %, high -rise syndrome 12.8%, dog bite 7.8%, unknown cau se of external wound 5.7%, gunshot 0.3%, and other trauma 30%. In uronephrological cases ( 432,7.74%), disea se distribution revealed renal failur e 55.3%, feline lower urinary tract disease 15.7%, hematuria 9.1%, urolithiasis 7.9%, dysuria 5.6%, cystitis 3.9%, urinary tract infection 2.1%, and others 0.4%. In respiratory system cases ( 350, 6.27%), diseases distribution revealed cough 32.9%, pantin g 25.4%, pulmonary edema 9.7%, pleural effusion 6.4%, pneumonia 6.3%, bronchitis 4.3%, tracheal collapse 3.7%, dyspnea2.3%, sneeze 2.0%, asthma 1.4%, pulmonary thromboembolism 0.6%, and others 5.0 %. In infectious diseases ( 298, 5.34% ), the primary caus es were canine distemper 55.4%, parvovirus infection 18.1%, feline infectious peritonitis (FIP ) 15.8%, leptospirosis 5.0%, toxoplasmosis 1.0%, feline immunodeficiency virus (FlY ) infection 0.7%, and others 4%. In metabolic and endocrinological cases ( 144, 2.58%), dise ase distribution revealed hypo glycemia 45.8%, diabetes mellitus 41.7%, hypocalcaemia or hypocalcaemia 4.9%, hypo adrenocorticism 2.8%, and others 4.8%. In musculoskeletal cases ( 123, 2.20%), disease distribution revealed back pain 35.8%, lameness 17.9%, spondylosis 13.0%, hip dysplasia 8.9%, patella luxation 5.7%, and others 18.7%. In theriogenological cases ( 120, 2. 15% ), disease distribution revealed pyometra 67.5%, dystocia 11.7%, prost ate gland hyperp lasia 3.3%, uterine prolaps e 2.5%, vaginal prolapse 1.7%, mastitis 1.7%, and others 11.6%. In hematological cases ( 109, 1.95% ), disease distribution revealed anemia 40.4%, epistaxia 11.9%, ehrlichiosis I I.0%, immune-mediated hemol ytic anemia ( IMHA) 8.3%, Babesia 6.4%, disseminated intravascular coagulation (DlC ) 4.6%, thrombocytopenia 3.7%, septic shock 2.5%, and others 11.2%. In oncological cases ( 99, 1.77% ), disease distribution revealed mammary gland tumor 19.2%, liver tumor 13.1%, spleen tumor 9.1%, lung tumor 6.1%, tran smis sibl e venereal tumo r ( TYT ) 3.0%, and others 49.5%. In neurological cases ( 20 I, 3.60 % ), disease distribution revealed seizure 51.2%, paral ysis or paraparesis 25.9%, head trauma 9.0%, ataxia 3.0%, tremors 2.0%, and others 8.9%. In dead-on-arrival cases ( 193, 3.46%), 94.1% were brought in for cremation and 5.9% for necropsy. In dermatological cases ( 186, 3.33% ), disease distribution revealed dermatitis 57.5%, allergy 15.1%, abscesses 9.7%, otiti s externa 7.5%, anal sac disease 3.2%, aural hematoma 2.2%, and others 4.8%. In toxicological cases ( 145, 2.60% ), disease distribution revealed unknown toxin 86.4%, rodenticide 4.8%, snake bite 3.4%, chocolate 2.0%, organophosphate 2.0%, ivermectin 0.7%, battery 0.7%. In ophthalmological cases (7 1, 1.27% ), dise ase distribution revealed conjunctivitis 45.1%, proptosed ( proptosis ) globe 15.5%, ulcerative keratitis 5.6%, bleeding 4.2%, glaucoma 4.2%, sudden blindness 1.4%, and others 24.0%. In environmental exposure cases ( 69, 1.23% ), disease distribution revealed heat stroke 40.6%, hypothermia 23.2%, electrocution 1.4%, and others 34.8%. In post-operative complications cases ( 32, 0.57% ), disease distribution revealed suture loss 43.8%, wound bleeding 15.6%, and others 40.6%. In other unclassified diagnosis cases ( 29 1,

5 262 Shu-Fang YANG et at 4.6% ), disease distribution revealed unknown shock 30.6%, fever 22.3 %, weakness 15.5%, medication ingestion 12.3%, health exam 1.1%, and others 18.2%. Outcome After emergency medical treatment, outpatients were 3757 cases (67.3%), in-patients 1138 cases (20.4%), mortalities 531 cases (9.5 %) and transfers 153 cases (2.7%) ( Fig. 8). Causes of death The causes of death for emergency cases were 193 dead-on-arrival, unknown causes (36.3%), 76 shock ( 14.3%), 73 heart failure (13.7%),42 trauma (7.9%; hit by car 24 ), 24 intoxication (4.5%), 18 gastroenterology (3.4%), 13 euthanasia (2.4%), 8 canine distemper ( 1.5% ), 8 tumor ( 1.5% ), 8 uronephrology ( 1.5% ), and other causes. Emergency Statistics All cases admitted to NTUVH for 18 months (from May 2004 to October 2005) were 58,478: 35,026 cases for the internal medicine section; 17,873 cases for the surgical section; and 5,579 cases for the emergency section. The emergency cases were 9.54% (5,579/58,478) of the total cases. DISCUSSION The major species of the NTUVH emergency cases were dog, the second major species seen were feline. The case numbers of the exotic species were 128. There has never been an exotic pet emergency center in Taiwan, so education on exotic species must be enhanced in the future. In the age group, the older age of the dog was a major factor. The mortality rate increased principally with the dog's age [4]. In the Pro- 70 (,I) 5U o our-patient 40 % in-patient.10 O J ealh 20 D tnmsfcr III O ur-pmicnt ln-patlcru Death Tra nsfer Fig. 8 The percent of the outcome after emergency medicine treatment schowsky' survey in Denmark, the median age at death for all dogs was 10.0 years [10]. It is very important to focus on the geriatric pet. Excluding mongrel breeds, the primary breeds of the dog was Maltese, Pomeranian and other small to medium breeds. The popularity ofthe dog or cat breed in the emergency cases may be relative to the popular breeds in the Taipei area. Case number percentage by admission time ( 10: 00 p.m. to 8:00 am) to the emergency room was about 38.5 %. The average case number was 3.9/day at the night ( 10:00 pm to 8:00 am ), and ranged from 0 to 14 cases. The number of night cases may be an indicator of urban lifestyles. On returning home, clients discovered that their pet was ill. This means that the necessity for the small animal emergency medical center is at night. Analysis of the systematic classification ofdiagnosis ofemergency medical cases reveals the most frequent cases were gastroenterological ( 1,356 cases or % ), cardiovascular diseases (696 cases; 12.48% ), and trauma (664 cases; 11.90%). Compared to the survey in insured dogs in Sweden during 1996, the most commonly affected system was the integument followed by the gastrointestinal and genital systems [5]. In Proschowsky' survey ofpurebred dogs in Denmark, diseases of the skin were most frequent ( 13.6%) followed by eye diseases ( 13.2%), accidents ( 12.6% ) and diseases ofthe ear ( 12.6%) [9]. The survey showed that the diseases ofthe emergency cases were different from general internal or surgery section cases. Focusing on the gastroentero!ogical, cardiovascular and trauma cases is very important at the small animal emergency medical center. In the Gobar's survey in the United States, by internet, proportional mortality rates of the most common causes of death were neoplasia, owner request (dog was geriatric, dog had poor quality of life, unspecified reason for euthanasia), renal failure, trauma, congestive heart failure, reason unknown, behavioral problems and parvovirus infection [6]. In Bonnett's survey of insured Swedish dogs, trauma, tumors and problems related to the locomotive system together accounted for more than 40 per cent ofall deaths or euthanasias [I]. During a 5 year survey in Sweden, the diagnostic mortality and general causes ofdeath were trauma, tumor, locomotive, heart and neurological [3].

6 The Ana lysis of Caseloads of24-hour Emergency Medical Service in National Taiwan 263 In their survey and our study, trauma was the frequent cause ofmortality in dogs. Owner education is important to prevent pet accidents and trauma. Death due to accidents had a slightly higher proportion (7.9%) in our survey compared to Edney ( 4.8% ) [2] and Michell (4.9%) [7]. The higher mortality may be because of different survey sections from emergency and general veterinarians. Death due to heart diseases in our study ( 13.7%) was higher than other surveys (4.6%) [10]. This result maybe because the emergency cases were geriatric and the major breed was small to medium dogs. After emergency medical treatment, ofthe 1,138 in-patient cases (20.4%), and 153 transfer cases ( 2.7% ), 20.4 % emergency cases needed to be hospitalized to provide critical care support. Because pet owners feel the hospital expense was too high or for other reasons, 2.7% emergency cases transferred to local clinics after emergency diagnosis and treatment. From May 2004 to October 2005, was the longest period of time an emergency service was maintained at the National Taiwan University Veterinary Hospital. Compared to Tufts Veterinary Emergency Treatment Services in Boston, Massachussettes, which managed 9,000 cases from a total hospital caseload of 22,000 ( 40.9%) [11],NTUVH managed 5,579 cases from a total hospital case load of58,478 (9.54%). These differences in case rates are an example ofanimal emergency hospital development progress between eastern and western countries. With the results of this study, we can better prepare for the more common emergency cases presented to our clinic and also focus on public education for prevention and control ofother causes ofsmall animal emergencies. ACKNOWLEDGMENTS This study was supported by a grant from National Taiwan University Veterinary Hospital (NTUVH: A9304 ). REFERENCES 1. Bonnett BN. Egenvall A. Olson P. Hedhammar A. Mortality in insured Swedish dogs: rates and causes of deat h in various breeds. Vet Rec 141: Edney ATB. Reasons for euthanasia of dogs and cats. Vet Rec 143 : Egenvall A. Bonnett BN. Hedhammar A. Olson P. Mortality in over insured Swedish dogs from :? Breed- specif ic age and survival patterns and re lative risk for causes of death. Acta Vet Scand 46 : Egenvall A. Bonnett BN. Olson P. Hedhammar A. Gender. age. breed and distribution of morbi dity and mortality in insured dogs in Sweden during 1995 and Vet Rec 146 ( 18) : Egenvall A. Bonnett BN. Olson P. Hedhammar A. Gender. age and breed pattern of diagnoses for veterinary care in insured dogs in Sweden during Vet Rec 146 ( 19) : Gobar GM. Case JT. I<ass PH. Program for surveillance of causes of death of dogs. using the internet to sur vey small animal veterinarians. J Am Vet Med Assoc 213: Michell AR. Longevity of British breeds of dogs and its relationships with sex. size. cardiovascular variables and disease. c ardiovascular variables and disease. Vet Rec 145 : Plunkett SJ. Emergency procedures for the small animal vet erinarian. 2th edi. W.B. Saunders Company. USA Proschowsky HF. Rugbjerg H. Ersbo ll AI<. Morbidity of purebred dogs in Denmark. Prev Vet Med 58: Proschowsi<y HF. Rugbjerg H. Ersbo ll AI<. Mortality of purebred and mixed-breed dogs in Denmarl<. Pre v Vet Med 58: Tufts Cummings School of Veterinary Medicine. Residency Int ern ship Programs. Tufts University. North Grafton. Massachusetts. U.S.A. Int ernet Site: / edu./ve t/residency/index.html.

7 264 Shu-Fang YANG ef al 台大附設動物醫院小動物急診加護中心病例分析 1 楊 ; 可是芳 l 賴筑玫 l 劉負怡 I 曾伊徵 l 劉奕志 I 黃繼霆 2 楊垣稜 2 梁碩麟 1 蔡函儒 * 1,3 郭宗甫 *1 固立台灣大學生物資源暨農學院附設動物醫院台北市 2 國立嘉義大學獸醫學研究所嘉義市 * 3 國立台灣大學獸醫學研究所台北市 ( 收稿日期 : 95 年 2 月 27 日 接受日期 : 9 5 年 8 月 2 4 日 ) J 商要台灣大學生物資源暨農學院附設動物醫院自 93 年 5 月開辦 24 小時小動物急診加護服務, 迄 94 年 1 0 月共 1 8 個月之急診病例進行分析 結果共有 個就診病例, 其中犬 4472 例 ( 80. 2% ), 貓 979 例 (17.5%), 其他小型動物 ( 如兔子 鼠 烏... 等 ) 128 例 (2.3% ) 疾病分類部分, 消化道疾病 例 (24.31%), 心血管疾病 696 例 ( % ), 外傷病患 664 例 ( % ), 泌原疾病 432 例 ( 7. 74% ), 呼吸 道疾病 350 例 ( % ), 傳染性疾病 298 例 ( 5. 34% ), 神經系統疾病 例 ( 3. 60% ), 到院已休克死亡 193 例 (3.46%), 皮膚疾病 1 86 例 ( 3. 33% ), 中毒病患 1 45 例 ( 2. 60% ), 內分泌代謝疾病 1 44 例 (2.58%), 肌肉骨絡系統疾病 1 23 例 ( % ), 生殖系統疾病 1 20 例 ( % ), 血液疾病 1 09 例 (1.95%), 腫瘤病患的例 ( 1. 77% ), 眼睛疾病 71 例 ( % ), 環境暴露傷害造成之病例的例 (1.23%), 術後併發症 32 例 ( 0. 57% ), 其他無法歸類疾病 例 ( 4. 6% ) 急診病患處置之後, 回家自行 照顧 例 ( 67. 3% ), 進一步住院進行治療 例 ( 2 0.4%), 死亡 53 1 例 ( 9. 5% ), 轉診 1 53 例 (2.7% ) 急診總病例數佔門診總病例數為 9. 54% (5,579158,478), 總結果可做為將來醫院急診之參考 [ 楊淑芳 賴筑攻 劉貞怡 曾伊徵 劉奕志 黃繼霆 " 楊短竣 果碩麟 蔡函儒 * 郭宗甫 台灣獸醫誌 3 2 (4): ' 2006 台大附設動物醫院小動物急診加護中心病例分析 * 聯絡人 TEL : , FAX: , tzongfu@ntu.edu.tw] 鐸訝 ; 含 59 醫學, /j\ 身呦, 自 */1(j, 震動均醫 fff