A down beef cap, is she gonna make
it or not.
That's question will explore as we look at
a research paper that ask about what impacts
whether those cows do well after being down.
Welcome. It's after the abstract. I'm Brad White.
Joined today by doctor Brian Lube. Good morning,
Brian. Morning, Brad. Brian, this is a great
1 of our Bo Science with Bc podcast
podcasts as we get a chance to go
through some of the papers that come out
in the literature and hopefully,
go through them in a way that will
provide some helpful information to you. And then
if you want, you can go look up
the papers.
As we go through these papers. If you
ever have a paper, or a topic that's
of interest to you that you'd like us
to talk about and read through. You can
send those to us at bc at KSU
dot edu.
But you picked a good paper for today.
It tell us about our paper today. Brian?
It's kind of an interesting topic. So the
title is pro
indicators about com in non ambulatory beef cattle,
presented to 2 referral hospitals, a retrospective study
of 63 cases, and it was published in
April of 20. So it's a recent article
in the journal of internal veterinary medicine. Yeah.
And the cool part is this is
between Auburn and K 4 state and and
some good faculty at both both institutions put
this together. And and really, they ask a
good
research question, which is where we start and
just to review, as we as we go
through and assess these papers,
we always start with the abstract and isn't
relevant to our clinical scenario.
Then we're gonna look at results, and then
we're gonna look at how they did it.
The materials and methods,
as well as how they drew some of
their conclusions and then finally, we'll we'll wrap
up with kinda of reviewing what what we
learned. So I wanna start there with the
abstract, Ryan. And when you look at it,
and
what do we see here that is it
relevant to us clinically or not? Yeah. And
I think so,
you know, and they kinda the the abstract
for
the journal of veterinary internal medicine
is broken down by section. And so they,
you know, they say the in the background,
You know, we know a little bit about
down syndrome and dairy cattle, but there's kind
of a lack of information and beef cattle.
And so I think I think it's actually
a really
very pertinent to what we're talking about. And
they're... In what we'd like to do here
in this podcast.
And their objective is clearly stated, they say
they evaluate the records of beef cattle, greater
than or equal to 2 years of age
presented at 2 referral hospitals.
To identify pro
indicators for survival to discharge. So, yeah. I
think that's pretty relevant to most practitioners our
practitioner audience anyway. Well, that's a come it's
a common thing. You get down cows in
in beef practice.
And the question is, are they gonna make
it or not? And and a lot of
times We just don't know the answer. So
what what is some of their kind of
major conclusions here as we decide, will it
influence the way I practice or or What
are some of the big things? Yeah. I
think,
probably the first big thing. And and again,
we're kinda digging...
Towards the bottom here, but, you know, if
you read through this,
it's pretty clear that beef cattle are not
dairy cattle. And so... Because because that's a
good conclusion. Yeah. Well, that's not what they.
That's my interpretation. That's your own own interpretation.
Yeah. Because what they found... So again, this
is a a retrospective analysis of cases
that presented to our referral hospital,
and they had 63
but only 12 of those survived. So they
were right right around 20 percent of the
cases
survived until discharged for beef cattle, But then
they quote, you know, in the literature, for
dairy cattle, the report the reported survival to
discharge ranges from, like, 30 to 50 percent.
So I think the 1 of the major
takeaways from this is the... As you said,
the prognosis is bad. If you have a
downer cow,
If it's a dairy cow. It's bad. If
it's a beef cow that presents like this.
It's it's really bad. So that... That's that
for me was a kind of a big
take home. Now,
with keeping that in mind, you know, 1
of their their objective is really, could they
identify things,
factors,
animal characteristics,
that would help pro
that. And so you could make the the
clinical decision earlier that this is a case
that we should keep moving forward with or
this is a case where we we probably
just the animal because a prognosis is not
good. So so that's that's really what they
did. And and again, keeping in mind, this
is a retrospective study. So that... It's a
different type of study. Right? So it's...
You use those studies for...
Diseases where
maybe they're not... There's not a high prevalence,
so, you know, they've looked
10 years, 12 years worth of hospital records
in 2 institutions and they came up with
63 cases that met their inclusion criteria. So
not many
and certainly, this isn't a a type of
disease where we could,
go out and we either do an induced
model or probably find enough cases
to to make some conclusions. So that's why
you would do a retrospective. You can take
a long look back and try to pool
enough cases to to at least get some
either form some more hypotheses or get some
preliminary findings on what are those pro factors.
So they looked at a lot of things.
They looked at
animal signal.
They looked at some blood chemistry values.
They looked at different management, hospital management strategies.
And 1 of the other big conclusions, and
I was a little bit surprised, most of
those things weren't p... Pro. So some of
the things that I would have anticipated would
have been pro would be non steroid treatment.
Right? I I would've have thought, you know,
non oils or cor.
You know, I thought, well, those probably have
a positive impact on case outcome. And and
they're
study they did not. I was kinda surprised
even more simply that there there's pretty good
split on which ones got cor
or not, which a lot of times in
a downer out. Oh, I'm like, yeah, yeah.
You He's she's probably gonna get some. Yeah.
So Yeah.
But that also probably speaks to...
They included a variety of diagnoses. And and
in fact, across their their 63
animals,
there were... And this is
retrospective case study. So you get this, There
were several that were not defined. Right? And
you had everything that range from true mu
skeletal to
maybe lymph sarcoma,
Gi, polio,
hardware. I mean, the whole gamut.
So you can see why some of those
would be infectious diseases and might not get
a cor stair. Yeah. That that that makes
sense to me once I've really kinda thought
it through. Yeah. And, you know, 1... You
know, we're... You're asking about big finding is
in conclusions. 1 of the things that was
associated with a positive prognosis was the diagnosis.
And so
beef cattle that had that came in with
a diagnosis of having peripheral nerve paralysis,
they they actually had a pretty good chance
of
an increased chance of survival to discharge. And
and pretty good in this population 50 50.
Yeah. Yes.
So better better than the other diet. Right?
But the other diagnoses like you said, includes
things life. This lymph sarcoma.
Sounds like it includes things like, major limb
fractures, so all of that's included. So, you
know, like I said, as you read through
it and you kind think about it, a
lot of these things do make sense, But
it... It's nice to have somebody that acts
looked at it. But I think I think
that's and I'll I'll just as as we're
going through results, and this is from table
2. So the 8 out of 18 were
discharged.
Mu skeletal spinal cord disease, only 1 out
of 17 was discharged,
and the other category, only 3 out of
25.
Were discharged. So you're you're right. I mean,
a 50 50 shot compared to
1 out of 17,
not super good at math, but I'd say
that's a lot better. Yeah. And I think
too, keep in mind with these numbers. The...
This is a different topic. Right. These are
animals that are presenting to a teaching hospital.
So there's already been some case select action.
So I don't know if that makes the
odds
better or worse. Right? Because we've probably already...
A lot of animals that had major limb
fractures were probably
on farm. It never would have come into
this. They wouldn't never be in this retrospective
study. So... But, yeah, You're right. I mean,
keep kinda keep in mind, it's... The... Those
factors are statistically associated.
But if you look at this paper, really
paying attention to those raw numbers, I think
is is important because it's still... Like you
said, it's still a coin flip for even
for ga paralysis.
Yeah. I think that's absolutely right. So as
we look through those tables and and they've
got a a breakdown of the different diseases,
different diagnoses.
They've got a table that that highlights
some of the
uni
analyses, and then they put them together in
a multi... Very process. And I think that's
maybe worth spending just a second on
is the the typical process when we have
a lot of variables that we wanna weight
in 1 of these retrospective analyses
is to look at each 1 of them
individually? Are they associated with our outcome of
discharge or not discharge. And then they put
them all together in a
single model which tells us okay, what were
kinda some of the major effects. And and
when they did that, only a few things
came up as significance. Is that right? Right?
Yeah. So in the the uni area analysis,
which is that first step that you talked
about where we're looking at each
variable
independently,
the age
was
statistically
significant. And as you would expect,
younger animals had a better prognosis.
And 1 more thing to to think about
is
some... A lot of these things
are also
confounded with, you know, people are making clinical
decisions as they went through these cases. Right?
And so, you know,
some of that is... Well, if I have
an older animal, I'm probably
less likely to put
invest more
resources or case management into that apple. And
the authors talk about that in the discussion
this paper, but you know, keep in mind
that this isn't this isn't necessarily a static
decision. We're we're making these decisions, like, they
all come together. She's an older animal.
Probably not as likely to be discharged simply
because I'm not gonna invest the same resources.
But age was significantly associated with outcomes.
Length of hospital stay was significantly
associated with outcomes, and and as you would
expect the longer
They stayed in the hospital, the more likely
they were to be discharged.
The number
I'm sorry. The... Yeah. The number of flotation
sessions
was significantly associated with discharge, although the total
time was not,
weight was not
associated with the prognosis. And I I would
have expected that lighter animals
would have done had a better prognosis simply
because we don't have the same
sequel. Like, if you have a down cow,
and you have a big down cow, There
are some other Sequel sequoia that happened that
I think would have had a negative impact
on prognosis.
Some of that may have just been
I mean, they did have a pretty wide
range of weights in both of these categories.
So... It's interesting too as you go through
the process, weight a little bit surprising.
Aids not surprising, but when they put everything
together in their final model,
it comes up flotation therapy.
Duration of hospital stay
pregnancy status at presentation
diagnosis
were were the only things that came up.
Here's where I think
we need to maybe distinguish this from some
of the other papers that we talk about.
When we... After we review the results and
the tables, we we go and talk about
appropriate control for bias.
Now, in this study, and we do a
lot of retrospective studies here as well,
my control for bias is, I can't. Right.
There's there's bias embedded in the data, and
the only way that I can manage from
a retrospective study, and they are really good
for hypothesis
generation. They're not great at sorting out c.
And maybe explain that a little bit, Brian
of what what kind of conclusions should I
make from not necessarily just this 1, but
retrospective studies in general. Yeah. And like you
said, and and again, I I really come
in the authors here for doing this work
because it's a question that hadn't really been
answered the the whole beef cattle aspect. And
and again, like I said, early in this
podcast,
you know, 1 of the big conclusions is
beef cattle and dairy cattle, prognosis is not
the same. For, at least from what's been
published on Dairy Cattle and this specific paper
and beef cattle. So I think, you know,
I I look at this paper as
it's helping
explore some of the things that might
help us make better clinical decisions. So... And
and like you said, they looked at a
lot of different factors, and and as you,
kinda jump in ahead a little bit to
the methods, but I mean, they had some
pretty good
inclusion and exclusion criteria. Right? And so the...
I think their cases are well defined.
1 of the challenges with retrospective
cases like this is
1 clinician might manage a case different than
a other. Meaning, 1 clinician might do blood
work and another 1 might not. Or 1
clinician as we mentioned, might treat with a
Cor steroid and 1 might not. And you
can't control for those things. So essentially,
at this stage of looking back at records
and trying to to
identify pro factors,
you kinda have what you have in those
records. And so they did... Actually lost a
few cases because there was just incomplete data
or missing data, and that's
again, all retrospective studies have those limitations. And
and... These authors do a good job in
the discussion of kinda talking about that. But
what you asked earlier,
we have to be very careful about saying
from a retrospective that this caused this. We
we really need to focus on and, you
know, we can say these 2 things are
associated.
Right? And I think we've kinda just as
an example from this paper that we've kind
of already talked about is
the the number of flotation of sessions was
associated with a positive outcome. Well, that could
be because
flotation
actually improves outcomes because we're
reducing
the the sequel sequoia like, creating Kinase build
and all that, or it could just be
the animals that the clinician has a more
positive prognosis for people are willing... The owners
are willing to go further,
there may be willing to invest a little
more, and they just get more flotation sessions,
not and not dying. And and not dying
because. Because if you die, you're not gonna
get many more flotation. That's true. Yeah. It's
kinda t it. Yeah. Yes. And so So
those 2... Like you said, we can't
sort those things out
retrospectively,
but we can say that those
1 factor and another factor are associated And
whether they're cause and effect or they just
moved together in the same direction But I
think it's a good starting point to say,
you know, and and maybe help
drive some questions about future research we might
do where you
I I said, you know, we wouldn't go
out and do an induced model,
but it might be something where you could
take this information and design a prospective study
and say Okay. In the future, when we
look at... When we have down cal cases,
we wanna
implement, you know, we wanna do these diagnostic
tests, we wanna look at these pro
factors. We wanna look at these signal issues
and and move that forward to to drive
a future research question. Really good point. And
and it affects how you interpret these studies
and you explain that really well because normally,
I'm asking you about
allocation to treatment groups,
randomization or blinding, neither of which in this
study are present nor do they matter. Right?
Right? We don't have them. If that's not
the type of study. However, the progression that
you described and and I like your your
flotation example is
if in this study I find flotation is
associated with a positive outcome. My next scientific
step would be, I will do a randomized
controlled clinical trial.
With the same type of cases that come
in and allocate them to either float or
don't float and then determined did did flotation
help. That's how we get to causality.
Right. More so than in the retrospective study
because you said it... Well, this could go
either way. And I think... But 1 point,
Brad, too, I don't want to... As a
clinician, does that mean? I should just ignore
this because it it lacks these
randomization and blinding factors. And I think the
answer is no. I I still think there's
some important
factors that they identified in this paper that
moving for until we... You know, it's kinda
1 of those things we often talk about
being paralyzed by a lack of data. Well
we have some data here that I think
is the study as a retrospective study is
still well designed. And so I wouldn't just
ignore these because it has those limitations. I
would just
interpret as, okay, if I if I saw
it downer cow beef cow tomorrow.
There are some things in here that I
would pay attention to. 1 is
I already know that the prognosis is really
bad. So I'm not gonna over pro
a downer beef cow. But
for example, out of this paper. If I
did my evaluation that animal, and I am
under the
my initial diagnosis is calvin paralysis.
That would change how I would manage it...
I would probably be a little
more optimistic about prognosis. And especially if I,
you know, maybe if it's a younger animal
with calvin paralysis, if a younger animal of
calvin paralysis, and I have some an owner
that's willing to invest in some flotation sessions.
You know, if I start stacking some of
these factors,
I I might... It might change how I
think about the case. They did a a
great job. The way you handle these studies
instead of blinding and randomization, we talk about...
Do they have a clear, repeatable case definition?
And did they handle their statistical analysis appropriately
and they did? Both those cases. So we
can draw some good conclusions here from a
clinical standpoint, and and I agree with what
you said
a young cow with calvin paralysis is gonna
have a different prognosis than some of the
cows with some of the other conditions or
an older cow, which which makes perfect sense,
but now I can put some numbers to
it. Yep. Yep. So as we
come through the materials and methods here and
and we kinda gloss over the
experimental units because in this case, it was
individual animal, and the data hierarchy, it was
nested within
each teaching hospital,
but that's 1 of the things that,
in the analysis, you can control for. So
any types of hierarchy you wanna be sure
you get in the analysis as you control
form. And you mentioned kinda some of the
ways that you would use this. Any other
conclusions from this 1, Ryan? Yeah. I think
there was 1
and I'm just not a conclusion. This is
specific finding out of this paper. There was
1 thing as I'm looking back through this.
They found was
if if an animal
walked out of the flotation tank after the
first session, that was a
very good pro agnostic indicator. And so,
again, I'm, I think we've touched on a
lot of the big things. You know, it's
The the limitation is... It's a retrospective study,
but it's a very good retrospective study,
and they're and it gives us some new
information about a different production class that in
the past, we haven't had any
information on. So, no. I think You know,
if you if you if I were to
somebody were to ask me to give them
an example of a good
retrospective study,
I'd certainly point them to this paper.
And then just like I said, the the
big conclusions about beef versus dairy,
and
association versus c association with some of these
factors,
and which ones pro
and and which ones didn't was... There were
a few that were surprising that they weren't
pro.
All all great information for a clinician looking
at at a a downer beef count. Totally
agree. And if if you're interested, this paper
is in
Jv
journal veterinary internal medicine, lead author was Perez
El, and the title was pro indicators of
outcome and non ambulatory beef cattle presented to
2 referral hospitals, a retrospective study. So
really nice job, Brian going through this. And
I mentioned at the top, but we we...
As we continue to do these, we do
appreciate your feedback. And if you have a
specific article, you'd us to take a look
at and discuss through. I always like getting
Brian's take on these, especially talking through some
of the experimental design and what should be
my take homes because it helps me sometimes
easier than reading them fine. So I appreciate
you doing that.
But if you have an article you'd like
us look at, you could certainly send us
at bc at k u dot edu e