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Evaluation of the rectal‐interdigital temperature gradient as a diagnostic marker of shock in dogs
Author(s) -
Schaefer Jonathan D.,
Reminga Christin L.,
Reineke Erica L.,
Drobatz Kenneth J.
Publication year - 2020
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.12992
Subject(s) - medicine , capillary refill , shock (circulatory) , perfusion , heart rate , vital signs , prospective cohort study , septic shock , respiratory rate , cardiology , blood pressure , anesthesia , sepsis
Objective To evaluate the difference in the rectal‐interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock. Design Prospective, single center, observational study conducted from 2014 to 2015. Setting University veterinary teaching hospital. Animals Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls). Measurements and main results Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT ( ρ = .353, P = 0.0013), tachycardia ( ρ = .3485, P = 0.0015), decreased DBP ( ρ = –0.6162, P = 0.0003), and shock index ( ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604). Conclusions The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted.