Clinical benchmarking
Application
VetCompass enables detailed review of clinical activities across the breadth of clinics in the UK that have provided useful clinical benchmarking data. A summary of some key benchmarks is provided for some common disorders along with reference to the full publications that can provide further context and detail. These benchmarks show the current status of UK primary care activities on a range of diagnostic, therapeutic, surgical and clinical outcomes. These values can underpin clinical audit activities by veterinary clinics by providing nation-wide metrics for comparison.
It is important to recognise that these benchmarks are not targets nor do they assume best practice; they merely reflect current activity. It cannot be assumed that decision-making processes are transferable between patients or contexts or that current management practices are reflective of recommended practice in every case.
These benchmarks are based on information recorded in the electronic patient records. It is likely that additional activities were undertaken that may not have been recorded, and consequently these benchmarks may misclassify some of these activities.
Corneal Ulcerative Disease (CUD) in dogs
These benchmarks were based on 834 CUD cases.
Diagnostics
Fluorescein staining: 774 (92.8%)
Schirmer tear test-1 (STT-1) strips: 198 (23.7%)
Bacteriology: 11 (1.3%)
None of the above: 53 (6.4%)
Management
Pain was recorded in 385 (46.2%)
At least one analgesic agent was used in 455 (54.6%)
Of the dogs given analgesia, the most commonly used analgesic agents were:
- Non-steroidal anti-inflammatory drugs (n = 421, 92.5%)
- Cycloplegics (36, 7.9%)
- Opioids (25, 5.5%)
- Local anaesthetic (24, 5.3%)
Surgical CUD management: 142 (17.0%)
Referred for advanced clinical management: 62 (7.4%)
Owners sought a second opinion at another primary-care practice: 13 (1.6%)
Transferred to the charity sector: 3 (0.4%)
Outcome
CUD resolution: 658 (78.9%)
Recurrence of CUD in the same eye: 45 (5.4%)
CUD contributing to death: 10 (13.5%) of 74 euthanasia decisions recorded.
Full paper available open access: https://cgejournal.biomedcentral.com/articles/10.1186/s40575-017-0045-5
Hyperadrenocorticism (Cushing's) in dogs
Diagnostics
ACTH stimulation test: 94.1%
LDDST: 32.0%
UCCR: 26.5%
Management
Treatment received after diagnosis:
- Trilostane: 94.1%
- Adrenalectomy: 0.5%
- No treatment: 5.4%
Starting trilostane dose: 3.30 mg/kg/day (*in 2009 – 2013. Starting doses have since changed in the Vetoryl SPC)
Mean lifetime dose: 3.09 mg/kg/day
Frequency of trilostane dosing:
- Once daily: 91.8%
- Twice daily: 8.2%
Suspected iatrogenic hypoadrenocorticism or adverse response to trilostane: 13.6%
Survival
Median survival time from the date of diagnosis of Cushing’s syndrome was 510 days (95% confidence interval: 412 – 618 days)
60% of dogs survived for 1 year following diagnosis
35% of dogs survived to 2 years following diagnosis
Full papers available:
Dystocia in dogs
These benchmarks were based on 701 dystocia cases attending first opinion emergency care practices.
Dystocia occurrence
Cause of dystocia; recorded for 260/701 (37.1%) bitches
Most common recorded causes:
- Foetal malposition: 90 (34.6%)
- Foetal-maternal disproportion: 80 (30.8%)
- Inertia (unspecified): 51 (19.6%)
- Primary inertia: 20 (7.7%)
Of 218/701 (31.1%) bitches with parity information recorded, 99 (45.4%) were primiparous.
Of 119/218 (54.6%) cases recorded as multiparous, 88 had information recorded on their breeding history which showed that 34/88 (38.6%) had previously had dystocia or caesarean section.
Diagnostic imaging was performed on 191/701 (27.3%) bitches:
- Radiography: 113/701 (16.1%)
- Ultrasonography 92/701 (13.1%)
Of 425/701 (60.6%) dystocia cases with litter size information available, the median total litter size was 4 puppies.
The median number of puppies born alive was 3, and the median number of puppies born dead was 1.
The median number of puppies alive at discharge from emergency care was 3.
Management
Oxytocin administered to 380/701 (54.2%) dystocic bitches
Median oxytocin dose at first administration: 0.36 IU/kg
124/380 (32.6%) bitches treated with oxytocin subsequently underwent caesarean section
Calcium gluconate administered to 82/701 (11.7%) bitches
80/82 given calcium gluconate (97.6%) also received oxytocin
Median dose calcium gluconate 10 per cent solution at first administration: 0.41 ml/kg
Caesarean section performed on 341/701 (48.6%) dystocia cases
106/341 (31.1%) of caesarean section surgeries included an ovariohysterectomy procedure
Outcome
12/701 (1.7%) dystocia cases died before discharge; 4 had unassisted deaths and 8 died by euthanasia.
Of 4/12 (33.3%) unassisted deaths, 1 died from gastric dilatation and volvulus, 1 died under general anaesthesia and 2 died from another systemic illness present at time of dystocia.
Of the 8/12 (66.7%) bitches that were euthanased, the owners’ decision was ascribed to financial concerns about the cost of caesarean section in 5/8 (62.5%) bitches.
511/701 (72.9%) dystocia cases completed their puppy delivery at the emergency provider
159/701 (22.7%) bitches returned home to continue whelping
31/701 (4.4%) were transferred to a routine day-care veterinary practice for continued clinical management
Full paper available open access: https://veterinaryrecord.bmj.com/content/vetrec/early/2019/01/23/vr.104944.full.pdf