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