Abstract
There are currently no evidence summaries on wounds in the horse. To develop evidence-based guidelines on wound management in the horse. Evidence review using the GRADE framework. Research questions were proposed by a panel of veterinarians, and developed into PICO format. Evidence in the veterinary literature was evaluated using the GRADE evidence-to-decision framework. Searches for human evidence summaries were conducted in the NICE, Cochrane and JBI databases. Final recommendations were based on both veterinary and human evidence. The research questions were categorised into three areas: A. Wound lavage and topical treatments; B. Wound debridement and closure; C. Therapeutics for wound healing. Three hundred and six veterinary publications were identified across thirteen different topics. Fourteen papers were assessed using the GRADE criteria. Twenty-five human evidence summaries were reviewed. The results were developed into recommendations: Wound lavage and topical treatments: (i) Tap water should be considered instead of saline for lavage; (ii) Povidone iodine lavage should be considered for contaminated wounds; (iii) Topical silver sulfadiazine may not be suitable for acute wounds; (iv) Optimal lavage pressures are around 13psi. Wound debridement and closure: (i) Debridement pads should be considered for wound preparation; (ii) Larvae debridement should be considered in selected cases; (iii) Hydrosurgery should be considered in acute contaminated wounds. Therapeutics for wound healing: (i) Honey may reduce duration of some phases of wound healing. There was insufficient evidence to draw conclusions on the use of chemical debridement, therapeutic ultrasound, laser therapy, wound closure with staples compared to sutures, or identify optimal concentrations of antiseptic lavage solutions. Low quality evidence in veterinary literature; majority of recommendations were based on human evidence. These findings should be used to inform decision-making in equine primary care practice.
Highlights
Wounds are the second most common emergency problem in the horse [1]
There was insufficient evidence to draw conclusions on the use of chemical debridement, therapeutic ultrasound, laser therapy, wound closure with staples compared to sutures, or identify optimal concentrations of antiseptic lavage solutions
Primary care clinical guidelines have been developed for analgesia in the horse using the GRADE framework [2], and this study was initiated to develop these for wounds in the horse
Summary
Treatment can be challenging due to the large variation in the type, location and severity of different wounds, and the lack of primary evidence on best management practice. The majority of literature around wound management is expert opinion or case series, and there are currently no evidence summaries to inform clinical decision-making. Primary care clinical guidelines have been developed for analgesia in the horse using the GRADE framework [2], and this study was initiated to develop these for wounds in the horse. The aim of this study was to develop evidence-based clinical practice guidelines on wound management in the horse. The objectives were to: Identify questions relevant to clinical practice on wound management through ranking by a panel of veterinary surgeons. Appraise the current veterinary evidence for each question through a systematic search of databases and assessment using the GRADE criteria
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