An owner questionnaire and cohort study on equine wounds and their management

Traumatic wounds have been described as the second most common reason for out-of-hours emergency veterinary visits in the horse. Sequelae of wound injury can pose a risk to life and return to pre-athletic function and incur significant treatment costs. Existing literature on equine wound healing and management has reported several factors to impact on wound outcome however, this body of research consists predominantly of retrospective studies specific to referral horse populations, expert opinion, and extrapolations from human medicine. The lack of high-quality evidence reported in the literature, particularly relating to concepts and current habits of owner attitudes towards wound management, served as the impetus for this project. The aim of this project was to generate primary evidence on the healing and outcome of wounds in horses, including documenting the attitudes and current habits of owners towards wound management and to perform descriptive and statistical analysis of the presenting signs, treatment and outcomes of these injuries. Data was captured through the use of an online questionnaire and prospective cohort study. The online questionnaire investigated how those involved in the care of horses would approach and manage seven hypothetical equine wound case scenarios with a focus on any first aid they would apply and factors influencing their decisions to seek veterinary advice. Dissemination was mainly facilitated using social media channels, and a total of 1037 responses were collected. Nearly all (95%) participants had previous experience of a horse under their care suffering from a wound. Over half of those participating would administer some form of first aid to each case, with approaches to treatment varying between participants. Despite most participants suggesting that the ‘depth of a wound’ would be the most influential factor in seeking veterinary advice, when presented with a puncture wound over the digital flexor tendon sheath only 22% stated the wound required high priority veterinary treatment. Additionally, owners were poor at both identification of exuberant granulation tissue and recognition that this condition requires veterinary intervention in order to promote healing. This study also identified a positive association between participants who had the horses under their care insured and whether they choose to seek veterinary advice for some case scenarios. Suggesting that the insurance status of a horse acts as a barrier to having access to veterinary treatment. These findings highlight significant gaps in owner knowledge of wounds which could result in their inappropriate management and therefore compromised animal welfare. A prospective cohort study was launched. Study advertisement, and subsequent participant recruitment, was achieved using social media channels and promotion within UK veterinary practices. A total of 219 wounds met inclusion criteria for this study, with outcome data available for 64% cases. Wounds were most commonly the result of contact with wire/fencing, with most injuries being sustained on the limbs (70%). Owners reported that many injuries involved deeper anatomic structures, such as tendon/ligament (17%), bone (17%) or synovial structures (16%). More than half of participants were reportedly administering some form of first aid however, a number of horses were identified whose owners had failed to adopt simple prophylactic measures that could mitigate the impact of traumatic wound injury. For example, 8% of horses that had wounds were not vaccinated against tetanus, 16% did not have access to emergency equine transport facilities. This study also found that over half of wounded horses included in this study were not insured for veterinary fees. Statistical analysis identified several factors, many of which have previously not been reported, which significantly impacted the rate of traumatic wound healing in the horse, return to work and cost of treatment. These include, for example, the horse’s age (P=0.013), gender (P=0.033), height (P=0.029), insurance status (P=0.04) and whether an owner had access to emergency equine transport facilities (P=0.002). Studies within this thesis are the first to investigate how horse owners currently approach and manage wounds. This evidence has highlighted factors which could significantly impact wound healing and outcome outside of a referral hospital setting and has identified key areas where further research is required. These findings should be utilised by both the horse owning population and veterinary professionals as valuable prognostic indicators, to determine both the success of wound healing and potential financial costs of treatment. Additionally, the findings have identified key areas where further research and public educational campaigns have the potential to significantly impact wound management practice and animal welfare