Physical examination and CT to assess thoracic injury in 137 cats presented to UK referral hospitals after trauma

Nicola Mansbridge,, Giorgio Kallis, Jinjing He, Isabelle Pearce, and Joy Fenner

Background: Some traumatic injuries may be identified by clinical examination. However, it is possible some injuries may be present without clinical exam abnormalities. This paper evaluates clinical exam and thoracic CT findings in cats after blunt trauma, and aims to identify the associations between them.

Study: The study is a multicentre, retrospective, observational study, involving 137 cats that had a history of blunt trauma and underwent thoracic CT at three private referral hospitals in the UK.

Methods: Data were collected on signalment, history, physical examination, thoracic CT findings and subsequent interventions. Fisher’s exact tests and binary logistic regressions were used to explore the relationships between physical examination findings, thoracic CT findings and the need for interventions.

Results: The most common cause of trauma was road traffic accidents (69%). The most common abnormalities identified on thoracic CT were atelectasis (34%), pulmonary contusions (33%), pneumothorax (29%) and pleural effusion (20%). Thoracocentesis was the most commonly performed intervention (12%), followed by chest drain placement (7%). A total of 45 (33%) cats had no physical examination abnormalities but did have abnormalities detected on thoracic CT; six of these cats required interventions. Increasing numbers of thoracic abnormalities on clinical examination were associated with increasing likelihood of having abnormal findings on thoracic CT (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.21–3.44, P = 0.008) and of requiring an intervention (OR 1.82, 95% CI 1.32–2.51, P <0.001).

• Pneumothorax: Cats with tachypnoea were 3.19 times more likely to have a pneumothorax detected on TCT.

• Contusions: Cats with reduced lung sounds were 3.65 times more likely to have contusions detected on TCT.

• Subcutaneous emphysema: Cats with dyspnoea were 6.94 times more likely to have subcutaneous emphysema detected on TCT.

Limitations: The main limitations of the study were its retrospective nature, the reliance on clinical notes, the subjectivity of physical examination findings, the lack of standardization in interventions before the original examination, the potential case selection bias and the absence of long-term outcomes.

Conclusions: The study concluded that thoracic CT may be useful in identifying cats with normal thoracic physical examination findings that have significant thoracic pathology, and that a high number of abnormal findings on thoracic examination should raise suspicion for both minor and major thoracic pathology. The results of this study can be used to assist in selecting appropriate cases for thoracic CT after blunt trauma.

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