Emergency visits to primary care veterinary hospitals

Published 15/04/2021

Written by Emi Kate Saito and Catherine Rhoads

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Emergency visits to primary care veterinary hospitals

Introduction

This paper will present some basic epidemiology of dogs seen for emergency care at a network of primary veterinary clinics in the United States of America. The findings presented in this paper are only intended to provide a bird’s eye view of the common causes of emergency visits to most primary care veterinary practices, and the progress and clinical outcomes for each category are beyond the scope of this paper.

Methods of analysis

The health records of all dogs presented at Banfield Pet Hospital during 2014 were screened to identify those that came in as an “emergency” visit. To be included, a case had to meet at least one of the following criteria: the reason for the visit was recorded as “emergency”, the owner was invoiced for “emergency medical treatment” (e.g., emergency/urgent/after hours care), or there was a diagnosis of “hit-by-car” (HBC). A count of the diagnosis entered at each visit was made; from this list, any condition likely to be unrelated to the reason for the emergency visit (e.g., dental calculus, nuclear sclerosis) was removed, and a list of the top 10 “emergency diagnoses” created. These were then grouped into 10 categories: dermatologic conditions (e.g., abrasion/wound/trauma, abscess, bites); HBC or bone fracture; respiratory disease (e.g., bronchitis, tracheal collapse, asthma, coughing, dyspnea); toxin exposure (e.g., plant, chemical or other medicinal toxicity); allergic reaction (e.g., anaphylaxis, urticaria); neurologic disease (e.g., seizures, anisocoria, vestibular disease); gastrointestinal disease (e.g., vomiting, diarrhea, hepatic disorder, pancreatitis); endocrine/metabolic disease (e.g., diabetes mellitus, diabetic ketoacidosis, adrenal disorder); urogenital disease (e.g., dystocia, pyometra, eclampsia, kidney disease, urinary tract obstruction); or nonspecific (e.g., malaise, anorexia, fever). Co-occurrence of certain problems (bone fracture, skin wound, respiratory disease or neurologic disease) related to a hit-by-car diagnosis was also investigated.

Results

Nearly 2.4 million dogs were seen in almost 7 million pet visits to Banfield Pet Hospital in 2014. This included 21,840 dogs (0.9%) seen for 22,625 “emergency” examinations, and of these, approximately 57.7% (13,056) of the visits had an exact diagnosis entered into the appropriate field of the health record. The top 10 breeds presented as an emergency are shown in Table 1; Chihuahuas and Labrador Retrievers were the most common breeds seen. Top diagnoses and the frequency of each diagnosis are shown in Tables 2a and b; HBC was the most common cause of an emergency, at 22.8% of all visits. Within the ten “emergency categories”, conditions within the “dermatologic” sector were most commonly encountered (25.4% of all cases), followed by the “HBC/bone fracture” category (24.5%). With regard to animals hit by a car, concurrent injuries were not uncommon, as shown in Table 3; for example 27.8% of dogs had related dermatologic wounds and 11.5% had bone fractures.

Table 1. Top ten breeds of dogs seen as an “emergency” visit in 2014*.
Dogs	Number of unique pets seen	Percentage of emergency pets
Chihuahua	2,114	9.7%
Labrador Retriever	1,932	8.8%
Pit bull	1,292	5.9%
Yorkshire Terrier	1,247	5.7%
Shih Tzu	1,060	4.9%
Dachshund	795	3.6%
Mixed breed	742	3.4%
German Shepherd	720	3.3%
Boxer	691	3.2%
Maltese	676	3.1%

* The list of the top affected breeds is very similar to their breed representation in the overall Banfield pet population seen during the course of the year.

Table 2a. Most common presentations for “emergency” visits.
Specific diagnosis	Number of emergency visits with this diagnosis	% of emergency visits with diagnosis
HBC (hit by car)	2,975	22.8%
Seizures	1,362	10.4%
Poisoning/toxicity	942	7.2%
Malaise	836	6.4%
Laceration	733	5.6%
Abrasion	717	5.5%
Wound from animal bite	590	4.5%
Allergic reaction**	501	3.8%
Allergic reaction (acute)**	406	3.1%
Hepatopathy	356	2.7%

** “Allergy” covers problems such as skin reactions whilst “acute allergy” was used for life-threatening or severe conditions.

Table 2b. The frequency of each diagnosis group for “emergency” visits.
Diagnosis group	Number of emergency visits	% of emergency visits
Dermatologic problems	3,322	25.4%
HBC/bone fracture	3,197	24.5%
Gastrointestinal	2,032	15.6%
Neurologic	1,694	13.0%
Toxin/poison	1,565	12.0%
Nonspecific	1,117	8.6%
Allergy/allergic reaction	1,077	8.3%
Respiratory	660	5.1%
Urogenital	319	2.4%
Endocrine/metabolic	242	1.9%

Table 3. Select comorbidities in dogs seen as hit-by-car “emergency” cases.
Number of HBC cases***	2,453
% with bone fracture	11.5%
% with dermatologic wound	27.8%
% with respiratory diagnosis	3.8%
% with neurologic diagnosis	1.9%

*** Note that the number of HBC cases are slightly less than the number of HBC visits given in Table 2a; this is because some animals had more than one visit for a HBC incident.

Discussion

The list of diagnoses from emergency visits will not be a surprise to the general practice veterinarian. It is tempting to suspect there might be a breed predisposition to having an injury or condition resulting in an emergency visit, but this is unlikely as the list of the top affected breeds is very similar to their breed representation in the overall Banfield pet population seen during the course of the year. It is possible that HBC as the most common diagnosis was biased, as the definition of an “emergency visit” for this study included all pets involved in a vehicle incident, irrespective of whether or not the animal was deemed to require an “emergency” visit. In addition, there is potential bias because over 40% of the cases did not have an exact diagnosis entered in the appropriate field of the health record; however, a random review of these cases found that their actual problems could be categorized with frequencies similar to those cases where a diagnosis had been entered. It is therefore unlikely that HBC cases (and indeed the other diagnoses) in Tables 2a and b are either over- or under-represented, and it is therefore reasonable to assume that the percentages for the co-occurrence of certain conditions related to car accidents, as shown in Table 3, are fairly accurate.

Emi Kate Saito

Dr. Saito qualified from the Veterinary Faculty at the University of Pennsylvania in 1997. She was awarded a Masters in Public Health by Emory University Read more

Catherine Rhoads

Catherine Rhoads, Banfield Pet Hospital, Portland, Oregon USA Read more

Emergency visits to primary care veterinary hospitals

Introduction

Methods of analysis

Results

Discussion

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