Risk factor analysis for "diagnosis not reached" results from bovine samples submitted to British veterinary laboratories in 2013-2017.

Routine diagnostic data from laboratories are an important source of information for passive animal health surveillance. In Great Britain, the Veterinary Investigation Diagnosis Analysis (VIDA) database includes records of diagnostic submissions made to a nationwide network of 28 veterinary post-mortem facilities (VPFs). Data on "diagnosis not reached" (DNR), i.e. where submissions do not lead to a confirmed diagnosis, are analysed quarterly to look for unexpectedly high incidences of DNRs which could indicate the presence of a new or emerging disease in British livestock populations. The objective of the present study was to provide a better understanding about the reasons of DNR occurrence and to inform improvements of the coverage and reporting of this kind of surveillance data. A subset of the VIDA database comprising diagnostic submissions from cattle received from 2013 to 2017 (122,444 records) was analysed. A mixed-effects multivariable logistic regression model, accounting for clustering by farm and county, was used to investigate associations between potential predictors and DNR. The variables included in the model were: VPF identity, animal sex, age, production purpose, main presenting sign of the animal from which the sample was obtained, and sample submission type. The variable that showed the strongest association with DNR was the main presenting sign of the animal, followed by submission type, VPF identity, animal age, sex, and production purpose, in that order. Submissions from animals with abortion as the main clinical sign had the highest odds ratio (OR 21.6, 95 % confidence interval [CI] 19.6-23.9, with mastitis taken as the baseline). Submissions where neither carcasses (i.e. a whole dead animal provided for post-mortem examination) nor foetuses (i.e. an unborn dead animal) were provided had approximately 12 times the odds of being DNR, compared to submissions of a carcass (OR 11.6, 95 % CI 10.7-12.5). In addition, submission type and main presenting sign can be considered as important confounders in the association between the other predictors and DNR. This study has helped characterise DNR occurrence and suggests some possible improvements that could be made to the passive surveillance system investigated, such as encouraging greater carcase submission, accounting for identified issues when interpreting increased occurrence of DNR and further investigating reduced submissions or greater DNR occurrence in some geographical regions.