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

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.

Not all euthanasias are alike: stratifying treatment effort to facilitate better prognosis prediction

“…Furthermore, with the exception of some common conditions, prognoses are still poorly defined in veterinary medicine 7 . Thus, the clinician's experience and the rarity of the disease are key determinants of prognostic accuracy and, in some cases, whether clients will proceed with treatment 9 …”

“…7 Thus, the clinician's experience and the rarity of the disease are key determinants of prognostic accuracy and, in some cases, whether clients will proceed with treatment. 9 A corollary of this is that, for younger clinicians and those in specialties defined by their breadth rather than depth (eg, zoological medicine),…”