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早期职业临床医生对非创伤性血腹但非胃扩张和扭转的犬实施安乐死的比例高于经验更丰富的临床医生。

Early career clinicians euthanize more dogs with nontraumatic hemoabdomen but not gastric dilatation and volvulus than more experienced clinicians.

出版信息

J Am Vet Med Assoc. 2022 Jul 28;260(12):1514-1517. doi: 10.2460/javma.22.05.0198.

Abstract

OBJECTIVE

To determine if clinician experience influenced the euthanasia rate in 2 common surgical emergencies.

ANIMALS

142 dogs with nontraumatic hemoabdomen (NTH) due to suspected ruptured splenic mass and 99 dogs with gastric dilatation-volvulus (GDV) where the owner either elected surgery or euthanasia.

PROCEDURES

Medical records were reviewed for dogs that had either NTH or GDV. For each patient, the owner's decision to pursue euthanasia versus surgery was recorded. The primary clinician was categorized as an intern, defined as a clinician with < 12 months experience, or a non-intern, defined as a clinician with more than 12 months experience. The euthanasia rates were compared used a Fisher exact, and the 95% CI was calculated for the risk of euthanasia if the primary clinician was an intern compared with a non-intern. If a difference was identified, subgroups comparing time of day, referral status, age, Hct, total solids, lactate, and heart rate were evaluated using a t test with a Bonferroni correction for the continuous variables and a Fisher exact for categorical variables.

RESULTS

For dogs with NTH, the euthanasia rate for cases primarily managed by non-interns (52%) was significantly lower than that of interns (76%; P = .005). The relative risk of euthanasia associated with NTH when the case was treated by an intern was 1.44 with a 95% CI of 1.1229 to 1.8567. For 99 dogs with GDV, the rate of euthanasia was not different between interns and non-interns.

CLINICAL RELEVANCE

The euthanasia rate for dogs with NTH may be impacted by the level of experience of the clinician. Support of new clinicians during challenging conversations should be provided.

摘要

目的

确定临床医生的经验是否会影响两种常见外科急症的安乐死率。

动物

142 只因疑似脾破裂肿块而患有非创伤性血腹(NTH)的狗和 99 只患有胃扩张-扭转(GDV)的狗,其中主人选择手术或安乐死。

程序

回顾了患有 NTH 或 GDV 的狗的病历。对于每只患者,记录了主人选择安乐死与手术的决定。将主要临床医生归类为实习生,定义为经验不足 12 个月的临床医生,或非实习生,定义为经验超过 12 个月的临床医生。使用 Fisher 精确检验比较安乐死率,如果主要临床医生是实习生,则计算 95%CI 比较实习生与非实习生的安乐死风险。如果发现差异,则使用 t 检验比较白天时间、转诊状态、年龄、Hct、总固体、乳酸和心率的亚组,对于连续变量使用 Bonferroni 校正的 t 检验,对于分类变量使用 Fisher 精确检验。

结果

对于患有 NTH 的狗,非实习生主要管理的病例安乐死率(52%)明显低于实习生(76%;P =.005)。当病例由实习生治疗时,NTH 相关的安乐死风险的相对风险为 1.44,95%CI 为 1.1229 至 1.8567。对于 99 只患有 GDV 的狗,实习生和非实习生的安乐死率没有差异。

临床相关性

NTH 犬的安乐死率可能受到临床医生经验水平的影响。应提供对新临床医生在具有挑战性的对话中的支持。

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