Received: 9 August 2021
Accepted for publication: 19 December 2022
Slov Vet Res 2022; 59 (4): 185–93
DOI 10.26873/SVR-1368-2022
UDC 636.8.09:616.831:616-001.1:614.86:616-089.17:005.585 
Original Research Article
Introduction
Head trauma is the most common injury in cats 
after extremity trauma (1). This type of trauma is 
commonly associated with motor vehicle accidents 
and high-rise syndrome (2, 3). Modified Glasgow 
Coma Scale (mGCS) and Animal Trauma Triage 
(ATT) are trauma-specific scoring systems used to 
classify trauma patients for prognostic purposes 
with quantification of injury severity (4–6). Trauma 
scores can facilitate the objective assessment of 
traumatized animals, and improve the outcome 
of treatments by predicting prognosis. The ATT 
score assesses six categories of body systems 
(perfusion, cardiac, respiratory, eye/muscle/
EVALUATION OF TRAUMA SCORING AND ENDOTHELIAL 
GLYCOCALYX INJURY IN CATS WITH HEAD TRAUMA
 Kurtulus Parlak1,*, Amir Naseri2, Mustafa Yalcin1, Eyup Tolga Akyol3, Mahmut Ok2, Mustafa Arican1     
1Department of Surgery, 2Department of Internal Medicine, Faculty of Veterinary Medicine, University of Selcuk, 42130, Konya, 3Department of 
Surgery, Faculty of Veterinary Medicine, Balikesir University, 10145, Balikesir, Turkey
*Corresponding author, E-mail: kparlak@selcuk.edu.tr
Abstract: This study aim to evaluate the modified Glasgow Coma Scale (mGCS) and Animal Trauma Triage (ATT) scores, labo-
ratory variables, and prognostic features of trauma-induced endothelial glycocalyx injury in cats with head trauma. Twenty-five 
cats with head trauma and 10 healthy cats were evaluated in this study. The enzyme-linked immunosorbent assay (ELISA) method 
was used to measure the levels of syndecan-1 and thrombomodulin in the serum of the 25 cats with head trauma (within 48 hours) 
and the 10 healthy cats. In addition, mGCS scores, ATT scores, laboratory values, syndecan-1 and thrombomodulin levels were 
compared between the cats that survived following treatment and the cats that did not survive despite treatment. Syndecan-1 
and thrombomodulin levels were not statistically different between healthy cats and cats with head trauma. In the cats with head 
trauma, the mGCS scoring system was found to be more sensitive than the ATT scoring system. In conclusion, syndecan-1 and 
thrombomodulin levels did not yield statistically significant results in the cats with head trauma.
Key words: animal trauma triage; cat; head trauma; modified Glasgow coma scale; endothelial glycocalyx
integument, skeletal, and neurologic) and a scale 
of 0 to 3 for each category (0-slight or no injury, 
3-severe injury), which contribute equally to the 
total score of 0 to 18 for prediction (5, 7). The 
mGCS was modified for veterinary use from the 
Glasgow Coma Scale, which has been described 
for humans with traumatic brain injury. This scale 
is based on the assessment of three categories, 
motor activity, brainstem reflexes, and level of 
consciousness. For each category, there is a scale 
from 1 to 6 (1-severely abnormal, 6-normal), with 
a lower total score indicating the more severe 
neurological deficits (4).
Recently, resuscitation efforts in severe trauma 
patients (humans, cats, dogs, etc.) have focused 
not only on restoring lost blood volume, but also 
on improving the recovery of inflammatory and 
coagulation responses, vascular permeability, 
K. Parlak, A. Naseri, M. Yalcin, E. T. Akyol, M. Ok, M. Arican186
and endothelial dysfunction (8, 9). In humans, 
head trauma and hemorrhagic shock are the most 
common causes of death in patients with trauma (10). 
In particular, hemorrhagic shock leads to systemic 
degradation of the endothelial glycocalyx layer, and 
these changes are thought to lead to traumatic 
endotheliopathy (EoT), a syndrome associated with 
high mortality (11–13). Therefore, biomarkers such 
as syndecan-1 and thrombomodulin have emerged 
for the assessment of coagulation and endothelial 
integrity (endothelial glycocalyx). In particular, 
hemorrhagic shock, sepsis, multiorgan failure, 
endothelial dysfunction, and damaged vascular 
permeability have been associated with increased 
morbidity and mortality (14, 15). 
Overall, the purpose of this study is to 
investigate the mGCS and ATT scores as well as 
laboratory variables and markers of endothelial 
glycocalyx dysfunction for prognosis in cats with 
head trauma. 
Materials and methods
Criteria for the selection of cases
Cats with a history of head injury (within 
48 hours) that met clinical and neurologic 
examination criteria (mGCS and ATT scores) were 
included in the study. Delayed (over 48 hours), 
treated cases, and cats with polytrauma were 
excluded from the study.
Scoring methods
Clinical examinations of the cats with head 
injuries were performed by the same observer (KP) 
using the mGCS and the ATT scoring systems 
before analgesic medication was administered. 
On the mGCS, consciousness, brainstem reflexes, 
and motor activities were rated in three scoring 
categories: 3 to 8, “grave”; 9 to 14, “guarded”; 15 
to 18, “good.” As with the ATT assessment, body 
systems were rated in six categories (perfusion, 
cardiac, respiratory, eye/muscle/integument, 
skeletal, and neurologic) and scored on a scale of 0 
to 3 in each category (4, 5).
CT imaging
A CT scan of the head was performed within 72 
hours after trauma when the patient’s condition 
had stabilized. The patient was premedicated 
with medetomidine hydrochloride (Domitor®, 
Zoetis) (0.08 ml/kg b.w., intramuscularly), 
and anesthesia was induced with propofol 
(Propofol %1, Fresenius Kabi) (4 - 6 mg/kg b.w., 
intravenously) and maintained with isoflurane 
(Forane®, Abbott) in oxygen via intubation tube. 
For the CT 120 kV, 100 mA, and 2 mm cross-
sectional thickness were selected and performed 
in helical cranial scanning mode. CT was used 
for head bone assessment only.
Blood sample collection
On admission, 2 ml of blood was collected by 
jugular venipuncture. Depending on the clinical 
condition of the cases, blood analyzes were 
repeated during the monitoring process. One part 
(0.5 ml) of the collected sample was immediately 
used for venous blood gas analysis, and the rest 
for complete blood count (CBC) and biochemistry 
(serum) analysis. Serums were stored at – 80 °C 
and thawed immediately before ELISA (enzyme-
linked immunosorbent assay) analysis.
Blood gases and complete blood count 
Venous blood gas analysis, which includes 
pH, partial pressure of carbon dioxide (pCO2), 
partial pressure of oxygen (pO2), venous oxygen 
saturation (sO2), lactate, sodium (Na), calcium (Ca), 
chloride (Cl), potassium (K), glucose, base excess 
(BE), and bicarbonate (HCO3) was performed 
using an automated blood gas analyzer (ABL 90 
Flex, Radiometer, USA). Blood counts including 
total leukocytes, lymphocytes, monocytes, 
granulocytes, erythrocytes, hematocrit (HCT), 
hemoglobin (Hgb), and platelets were obtained 
using an automated cell counter (MS4e, Melet 
Schlosing Laboratories, France).
Measuring syndecan-1 and thrombomodu-
lin by the ELISA method
Serum concentrations of syndecan-1 and 
thrombomodulin were measured according to 
the manufacturer’s protocol using the feline 
syndecan-1 commercial sandwich ELISA kit 
(catalog number: MBS1603385, USA) and the feline 
thrombomodulin commercial ELISA kit (catalog 
number: MBS1603383, USA) with an ELISA reader 
(Biotek 800TS, BioSPX, The Netherlands). Intra-
Evaluation of trauma scoring and endothelial glycocalyx injury in cats with head trauma 187
assay coefficients, inter-assay coefficients, and 
minimum detectable concentrations were < 8%, < 
10%, and 0.025 ng/ml for syndecan-1 cat, < 8%, < 
10%, and 0.017 ng/ml for thrombomodulin.
Treatment protocol
The treatment protocol was applied to the cats 
with head trauma immediately after scoring and 
blood collection, and this protocol was repeated 
depending on the condition of the patients in the 
intensive care unit. The goals of the treatment 
protocol were based on the stimulation of 
circulation and oxygen delivery to vital organs. 
Fluid therapy with crystalloid solution 0.9% NaCl 
(60 ml/kg/hour, b.w., intravenously), osmotic 
diuretic mannitol (20% Mannitol, Polifarma) (2 
g/kg b.w., intravenously, in 15 minutes), oxygen 
therapy (flow rate 100 ml/kg/min, intranasal or 
flow-by, oxygen cage), butorphanol (Butomidor®, 
Richter Pharma) (0.4 mg/kg b.w., subcutaneously) 
for analgesia, levetiracetam (Keppra®, UCB 
Pharma) (40 mg/kg b.w, intramuscularly) for 
anticonvulsant therapy, and nutrition (oral 
feeding or nasogastric tube feeding and esophageal 
feeding) were performed in cats with head trauma.
Statistical methods
To determine if  the variables had a normal 
distribution, the Shapiro-Wilk test was used. In 
addition, parametric data were analyzed with the 
Student t-test (as mean ± standard deviation (SD)), 
nonparametric data were analyzed with the Mann-
Whitney U test (as median (min/max)), and linear 
regression analysis was performed to determine the 
independent predictors of  mortality. The prognostic 
value of  serum endothelial biomarkers, mGCS, and 
hematologic variables was also evaluated using a 
receiver operating characteristic curve (ROC) to 
determine the prognostic cut-off  values for best 
discrimination between survivors and nonsurvivors. 
Finally, the Kaplan-Meier survival curve from GCS 
was constructed. Overall, the statistical significance 
was P < 0.05, and data analysis was performed using 
SPSS statistical software.
Results
The animals in this study consisted of 25 cats 
with acute head trauma (24 mixed-breed and 
one British Shorthair; 14 males and 11 females; 
mean age, 13.4 (1-48) months) and 10 healthy cats 
(control group) (10 mixed-breed; 6 females and 4 
males; mean age, 15.2 (8-28) months).
Of the 25 cats with head trauma, 5 cats (20%) 
had trauma due to high-rise syndrome and 20 
cats (80%) had trauma due to motor vehicle 
accidents. In addition, 8 cats (32%) had severe 
head trauma (mGCS score 3 - 8, “grave”), 10 cats 
(40%) had moderate head trauma (mGCS score 9 
- 14, “guarded”), and 7 cats (28%) had mild head 
trauma (mGCS score 15 - 18, “good”). Compared 
with the mGCS scores, the ATT scores ranged from 
5 - 14 (mean 9) in the cats with severe trauma, 
from 4 - 12 (mean 7.5) in the cats with moderate 
trauma, and 2 - 7 (mean 4.7) in the cats with mild 
trauma (Table 1).
CT scan was performed in 15 / 25 cats with 
head trauma. The CT could not be performed in 
8 cats because of their poor clinical condition 
and in 2 cats because their owners did not give 
permission. There were no abnormal findings in 2 
/ 15 cats. In addition, in 1 of the cats in which 
a CT scan was not performed, separation of the 
mandibular symphysis was clinically detected and 
treated. Regarding the CT findings of the other 
cats, separation of the symphysis mandible (n = 
8), temporomandibular joint (TMJ) fracture (n = 
5), os temporale fracture (n = 1), os zygomaticus 
fracture (n = 2), and separation of the palatal bone 
(n = 8) were observed (Table 1). There were no 
complications related to anesthesia during the CT 
scans. 
Finally, 12 of the 25 cats with head trauma were 
discharged after treatment (the average treatment 
time for discharged cats is 96 hours), whereas the 
remaining 13 cats died (no cat was euthanized). 
In this context, hematologic values, trauma scores 
(mGCS, ATT), and endothelial glycocalyx layer data 
(syndecan-1, thrombomodulin) were statistically 
compared between non-surviving and surviving 
cats (Figure 1) (Table 2).
Linear regression analysis showed that mGCS, 
K+, HCO3, WBC, and Hb were independent risk 
factors for mortality in the head trauma group, 
whereas ROC analysis for the benefit of mGCS 
in discriminating between surviving and non-
surviving cats yielded an area under the curve 
of 0.76 (p = 0.028, 95% CI = 0.569-0.950) (Fig-
ure 2). Furthermore, the optimal cut-off point of 
14.50 for the mGCS corresponded to a sensitiv-
ity of 76% and a specificity of 70% for predicting 
K. Parlak, A. Naseri, M. Yalcin, E. T. Akyol, M. Ok, M. Arican188
Case TraumaType CT Results mGCS ATT
Survivors/
Non-survivors
Cat 1 HRS TMJ Fracture (Left)Os zygomaticus fracture 14 8 N
Cat 2 MVA CT not applied 17 2 N
Cat 3 MVA TMJ Fracture (Right) 16 7 N
Cat 4 MVA CT not applied 5 9 Y
Cat 5 MVA CT not applied 6 9 N
Cat 6 MVA CT not applied 3 5 N
Cat 7 MVA CT not applied 4 6 N
Cat 8 MVA Separation of the symphysis mandible 18 7 Y
Cat 9 MVA TMJ fracture (Left)Separation of the symphysis mandible 16 5 Y
Cat 10 MVA Separation of the palatal bone 16 3 Y
Cat 11 MVA
TMJ Fracture (Right)
Separation of the symphysis mandible
Separation of the palatal bone
3 11 N
Cat 12 MVA Os temporale fractureSeparation of the palatal bone 12 5 Y
Cat 13 MVA Separation of the symphysis mandibleSeparation of the palatal bone 15 7 Y
Cat 14 HRS Different structure not seen 14 9 N
Cat 15 MVA Separation of the symphysis mandible 14 9 N
Cat 16 MVA Separation of the symphysis mandibleSeparation of the palatal bone 10 6 Y
Cat 17 MVA TMJ fracture (Right)Separation of the palatal bone 11 7 N
Cat 18 MVA
Os zygomaticus fracture
Separation of the symphysis mandible
Separation of the palatal bone
5 10 N
Cat 19 HRS Different structure not seen 13 8 N
Cat 20 MVA Separation of the palatal bone 9 4 Y
Cat 21 MVA CT not applied 6 7 Y
Cat 22 HRS CT not applied 18 2 Y
Cat 23 MVA CT not applied 13 7 Y
Cat 24 MVA CT not applied 13 7 Y
Cat 25 HRS CT not applied 4 14 N
Table 1: Trauma scores and findings on cases
HRS: High-Rise Syndrome, TMJ: Temporomandibular Joint, MVA: Motor vehicle accidents, mGCS: Modified Glasgow Coma 
Scale, ATT: Animal Trauma Triage, Y: Survivors, N: Non-survivors
mortality. Finally, a probability curve for the mGCS 
score showed a 72% probability of nonsurvival at 
a score of 6 and a 56% probability of non-survival 
at a score of 13, whereas a mentation score of 3 
showed a 92% probability of nonsurvival (Figure 3).
Discussion
The primary causes of head injuries are traffic 
accidents, followed by high-rise syndrome (3). 
Of the 25 cats with head trauma in the present 
study, 80% were due to motor vehicle accidents, 
whereas 20% were due to high-rise syndrome, 
which is consistent with the results of previous 
studies.
Some researchers have evaluated different 
scoring systems, such as the mGCS and ATT 
scoring systems, as prognostic indicators of 
trauma in cats and dogs (4, 7, 16). For instance, 
Lapsley et al (7) studied the mGCS and ATT 
scoring systems in 711 cats with trauma.
Evaluation of trauma scoring and endothelial glycocalyx injury in cats with head trauma 189
However, when they limited the study to patients 
with head trauma, they found that there was 
no significant difference in differential capacity 
between the two scoring systems. 
In a related study, Sharma and Holowaychuk 
(16) performed prognostic assessments of 72 dogs 
Figure 1: Comparison of the syndecan-1 (left) and thrombomodulin (right) levels of healthy cats and cats with 
head trauma
Figure 2: Receiver operating characteristic curve 
(ROC) analysis for the utility of the modified Glasgow 
Coma Scale to discriminate between surviving and 
nonsurviving cats yielded an area under the curve of 
0.76 (p = 0.028, 95% CI = 0.569 - 0.950)
Figure 3: A probability curve for the modified Glasgow 
Coma Scale score showed a 72% probability of 
nonsurvival at a score of 6 and a 56% probability of 
nonsurvival at a score of 13, whereas a mentation 
score of 3 showed a 92% probability of nonsurvival
with head trauma and found that both scoring 
systems, particularly the mGCS, had prognostic 
value. In addition, Platt et al (4) reported that the 
mGCS can be evaluated as prognostic data in dogs 
with head trauma. In the present study, when the 
mGCS and ATT scores of the non-surviving and 
K. Parlak, A. Naseri, M. Yalcin, E. T. Akyol, M. Ok, M. Arican190
surviving cats were compared, it was found that 
the mGCS was statistically more prominent in head 
trauma in terms of prognosis. It was also suggested 
that the lack of statistical prognostic value of the 
ATT system was since this study focused only on 
cats with isolated head trauma and not on cats with 
polytrauma. It is important to note that the ATT 
scoring system generally assesses all body systems, 
including the musculoskeletal system, whereas the 
mGCS provides a more specific assessment of the 
central nervous system.
In general, CT scans are used to diagnose 
hematomas, contusions, hernias, and cerebral 
ischemia, especially fractures in patients with 
head trauma (17, 18). It has also been used in the 
determination of craniomaxillofacial fractures in 
cats with head trauma. Recent studies report that 
mandibular fractures, particularly the separation 
of the mandibular symphysis and TMJ fractures, 
are the most common injuries diagnosed with CT 
Parameter Survivors(n: 12)
Non-survivors
(n: 13) P-value
mGCS 14 (6 - 18) 6 (3 - 17) 0.026
ATT 6 (2 - 12) 8 (2 - 14) 0.110
Syndecan-1 (ng/ml) 2.49 ± 0.94 2.59 ± 1.34 0.827
Thrombomodulin (ng/ml) 1.14 ± 0.30 1.02 ± 0.29 0.319
pH 7.32 ± 0.49 7.26 ± 1.12 0.076
pCO2
 (mmHg) 35.02 ± 5.90 35.56 ± 5.73 0.818
pO2 (mmHg) 36.54 ± 6.18 34.06 ± 4.01 0.255
sO2  (%) 47.62 ± 14.17 44.38 ± 8.64 0.503
cK+ (mmol/L) 3.72 ± 0.58 3.19 ± 0.68 0.047
cNa+ (mmol/L) 159.58 ± 3.08 159.53 ± 9.68 0.988
cCa+ (mmol/L) 0.87 ± 0.19 0.81 ± 0.22 0.452
cCl- (mmol/L) 120 (116 - 125) 121 (92 - 181) 0.205
cGlu (mg/dL) 209.58 ± 52.64 212.76 ± 66.50 0.895
cLac (mmol/L) 3.00 ± 1.75 2.13 ± 1.34 0.182
cBase (Ecf) (mmol/L) -7.70 ± 1.55 - 10.21 ± 4.05 0.055
cHCO3
-  (mmol/L) 17.90 ± 1.13 16.05 ± 2.63 0.034
WBC (cells/ml) 26.36 ± 11.65 15.79 ± 9.22 0.021
LYM (cells/ml) 7 (1 - 18) 5 (2 - 15) 0.247
MON (cells/ml) 1 (0.14 - 12) 0.99 (0.51 - 4) 0.437
GRA (cells/ml) 14.12 ± 8.28 8.67 ± 7.80 0.105
RBC (x103 cells/ml) 10.66 ± 1.93 8.72 ± 2.72 0.051
Hct (vol%) 44.07 ± 9.65 36.12 ± 11.26 0.070
Hgb (g/dl) 12 (8 - 45) 10 (7 - 16) 0.022
Platelets (cells/ml) 199.58 ± 101.84 214.76 ± 76.02 0.679
Table 2: Mean trauma scores (mGCS, ATT), endothelial glycocalyx layer data (syndecan-1, thrombomodulin), and 
hematologic values were statistically compared between nonsurviving and surviving cats
in cats after head trauma (19, 20). In addition, 
Tundo et al (20) stated that fractures involving 
the skull in cats after head trauma had a 
common and predictable distribution pattern in 
the midface (nose, maxilla, intermaxillary suture, 
orbit, nasopharynx, and zygomatic arch), with a 
high incidence of TMJ fractures. According to 
the CT scans in this study, the most common 
injuries were the separation of the mandibular 
symphysis, separation of the palatal bone, and 
TMJ fractures. The results are consistent with 
those of recent studies (19, 20). It is important 
to point out that one of the main problems 
that limited our CT imaging method was the 
inadequacy of the older generation of equipment, 
which prevented us from scanning thinner 
sections and obtaining detailed views of small 
structures.
Some retrospective studies have been 
performed to determine the association between 
Evaluation of trauma scoring and endothelial glycocalyx injury in cats with head trauma 191
the severity of injury and hyperglycemia in cats 
and dogs with head trauma. Thus, some studies 
have indicated that cats and dogs with head 
trauma may have hyperglycemia, the extent of 
which is related to the severity of head trauma 
(16, 21). However, in the present study, no 
statistically significant difference was found 
between hyperglycemia and mortality, based on 
the statistical analyses between non-surviving 
and surviving cats with head trauma. However, 
blood glucose levels were found to be higher than 
normal in the cats with head trauma.
In this study, Hgb, HCO3, and K
+ levels 
decreased below normal values on laboratory 
examination of non-surviving cats at the time 
of admission. Their white blood cell counts, 
although at normal levels, were lower than those 
of the surviving cats. In addition, a decrease in 
venous pO2 was observed in all cats with head 
trauma, including both non-surviving and 
surviving cats. Previous studies have shown 
that such a decrease, especially in dogs with 
head trauma, is due to impaired hemodynamic 
stability, which may lead to secondary brain 
damage (16). According to the data of the present 
study, this situation may also occur in cats with 
head trauma. 
Previous studies have shown an association 
between the detachment of glycocalyx 
components (syndecan-1 and thrombomodulin) 
and increased morbidity and mortality (22, 23). 
A previous study by Albert et al (24) examined 
the effects of endothelial damage on mortality 
by focusing on syndecan-1 and thrombomodulin 
levels in human patients with a head injury. They 
found that there was no significant increase in 
syndecan-1 levels associated with traumatic 
brain injury (TBI), which is a determinant of 
endothelial glycocalyx damage, and no significant 
change in thrombomodulin levels. However, they 
found a significant association between increased 
syndecan-1 levels and mortality (24). In a related 
study, Rodriguez et al (25) examined endothelial 
glycocalyx dysfunction using syndecan-1 
and thrombomodulin levels in isolated TBI, 
polytraumatic TBI, and TBI-free trauma patients. 
They determined that syndecan-1 levels were 
highest in the polytraumatic TBI group, whereas 
they were lowest in the isolated TBI group. They 
also pointed out that thrombomodulin levels, 
although higher than normal, were similar in 
the three groups. In addition, the isolated TBI 
patients reported experiencing less glycocalyx 
destruction, as measured by their circulating 
syndecan-1 levels. Again, increased syndecan-1 
concentrations were associated with increased 72 
hours mortality in the isolated TBI patients (25).
Because there have been no previous studies 
of syndecan-1 and thrombomodulin levels in 
cats with head trauma, the results of the present 
study were compared with those of human 
studies. According to studies, the syndecan-1 
levels were increased in the endothelial glycocalyx 
damage of patients with head trauma, and this 
was more strongly associated with mortality 
than the increase in thrombomodulin levels. 
However, in our study, there was no statistically 
significant result related to syndecan-1 and 
thrombomodulin levels in the cats that did not 
survive after head trauma. Therefore, the results 
of this study differ from those of human studies 
and the use of different biomarkers related to 
endothelial glycocalyx injury may lead to more 
efficient results. 
Our study had several limitations: 1) the 
study population was relatively small, and 
reevaluation of the hypothesis of endothelial 
glycocalyx damage in larger sample populations 
is warranted. 2) Histopathological examinations 
were not performed on cats that did not survive 
after head trauma.
Conclusion
This was the first study to perform prognostic 
assessments based on the mGCS and ATT 
scoring systems and endothelial glycocalyx 
layers in cats with head trauma. Overall, no 
statistically significant difference was found 
between the syndecan-1 and thrombomodulin 
levels of the healthy cats and those of the cats 
with head trauma. In addition, linear regression 
analysis showed that the mGCS, potassium, 
bicarbonate, white blood cell, and hemoglobin 
levels were independent mortality factors in 
the head trauma group. Although the mGCS 
and ATT scoring systems are the most common 
scoring systems used to assess cats with trauma, 
the former is believed to be one step ahead of 
the latter. However, the markers syndecan-1 and 
thrombomodulin were not found to be useful for 
prognosis or choice of treatment options in cats 
with head trauma.
K. Parlak, A. Naseri, M. Yalcin, E. T. Akyol, M. Ok, M. Arican192
Acknowledgements
Supported by the Coordination of Scientific 
Research Projects of Selçuk University (BAP) (No. 
19401043). The authors thank N. Zamirbekova 
and all staff from the Department of Surgery for 
animal care.
Ethical approval: This study was approved 
by the Ethics Committee (03/2019) of the 
Faculty of Veterinary Medicine and Experimental 
Animal Production and Research Centre, Selçuk 
University, Turkey. Informed owner consent was 
also obtained from the owners and the ethical 
guidelines of the institution were followed.
References
1. Kolata RJ. Trauma in dogs and cats: an 
overview. Vet Clin North Am Small Anim Pract 
1980; 10: 515–22.
2. Rochlitz I. Study of factors that may predis-
pose domestic cats to road traffic accidents: Part 
2. Vet Rec 2003; 153(19): 585–8.
3. Vnuk D, Pirkić B, Matičić D, et al. Feline 
high-rise syndrome: 119 cases (1998–2001). J 
Feline Med Surg 2004; 6: 305–12.
4. Platt SR, Radaelli ST, McDonnell JJ. The 
prognostic value of the modified Glasgow coma 
scale in head trauma in dogs. J Vet Intern Med 
2001; 15: 581–4.
5. Rockar RA, Drobatz KS, Shofer FS. Devel-
opment of a scoring system for the veterinary 
trauma patient. J Vet Emerg Crit Care 1994; 4: 
77–83.
6. Shores A. Craniocerebral trauma. In: Kirk 
RW, ed. Current veterinary therapy X. Philadel-
phia : WB Saunders, 1983: 547–54.
7. Lapsley J, Hayes GM, Sumner JP. Perfor-
mance evaluation and validation of the Animal 
Trauma Triage score and modified Glasgow coma 
scale in injured cats: a Veterinary Committee on 
Trauma registry study. J Vet Emerg Crit Care 
2019; 29: 478–83.
8. Midwinter MJ, Woolley T. Resuscitation 
and coagulation in the severely injured trauma 
patient. Philos Trans R Soc B Biol Sci 2011; 366: 
192–203.
9. Pierce A, Pittet JF. Inflammatory response 
to trauma: implications for coagulation and re-
suscitation. Curr Opin Anaesthesiol 2014; 27: 
246–52.
10. Oyeniyi BT, Fox EE, Scerbo M, Tomasek 
JS, Wade CE, Holcomb JB. Trends in 1029 
trauma deaths at a level 1 trauma center: Impact 
of a bleeding control bundle of care. Injury 2017; 
48: 5–12.
11. Chignalia AZ, Yetimakman F, Christiaans 
SC, et al. The glycocalyx and trauma: a review. 
Shock 2016; 45: 338–48.
12. Johansson PI, Stensballe J, Ostrowski 
SR. Shock induced endotheliopathy (SHINE) in 
acute critical illness: a unifying pathophysio-
logic mechanism. Crit Care 2017; 21(1): e25. doi: 
10.1186/s13054-017-1605-5.
13. Johansson PI, Henriksen HH, Stensballe 
J, et al. Traumatic endotheliopathy: a prospec-
tive observational study of 424 severely injured 
patients. Ann Surg 2017; 265: 597–603.
14. Lee WL, Slutsky AS. Sepsis and endothelial 
permeability. N Engl J Med 2010; 363: 689–91.
15. Haywood-Watson RJ, Holcomb JB, Gon-
zalez EA, et al. Modulation of syndecan-1 shed-
ding after hemorrhagic shock and resuscitation. 
PLoS One 2011; 6(8): e23530. doi: 10.1371/jour-
nal.pone.0023530.
16. Sharma D, Holowaychuk MK. Retrospec-
tive evaluation of prognostic indicators in dogs 
with head trauma: 72 cases (January–March 
2011). J Vet Emerg Crit Care 2015; 25: 631–9.
17. Kolias AG, Guilfoyle MR, Helmy A, Allan-
son J, Hutchinson PJ. Traumatic brain injury in 
adults. Pract Neurol 2013; 13: 228–35.
18. Currie S, Saleem N, Straiton JA, Mac-
mullen-Price J, Warren DJ, Craven IJ. Imaging 
assessment of traumatic brain injury. Postgrad 
Med J 2016; 92: 41–50.
19. Knight R, Meeson RL. Feline head trauma: 
a CT analysis of skull fractures and their man-
agement in 75 cats. J Feline Med Surg 2019; 21: 
1120–6.
20. Tundo I, Southerden P, Perry A, Haydock 
RM. Location and distribution of craniomaxillo-
facial fractures in 45 cats presented for the treat-
ment of head trauma. J Feline Med Surg 2019; 
21: 322–8.
21. Syring RS, Otto CM, Drobatz KJ. Hyper-
glycemia in dogs and cats with head trauma: 122 
Cases (1997–1999). J Am Vet Med Assoc 2001; 
218: 1124–9.
22. Rahbar E, Baer LA, Cotton BA, Holcomb 
JB, Wade CE. Plasma colloid osmotic pressure 
is an early indicator of injury and hemorrhagic 
shock. Shock 2014; 41: 181–7.
Evaluation of trauma scoring and endothelial glycocalyx injury in cats with head trauma 193
23. Torres Filho I, Torres LN, Sondeen JL, 
Polykratis IA, Dubick MA. In vivo evaluation of 
venular glycocalyx during hemorrhagic shock in 
rats using intravital microscopy. Microvasc Res 
2013; 85: 128–33.
24. Albert V, Subramanian A, Agrawal D, Pati 
H, Gupta S, Mukhopadhyay A. Acute traumatic 
endotheliopathy in isolated severe brain injury 
and its impact on clinical outcome. Med Sci 
2018; 6(1): e5.  doi: 10.3390/medsci6010005.
25. Rodriguez GE, Cardenas JC, Cox CS, et 
al. Traumatic brain injury is associated with in-
creased syndecan-1 shedding in severely injured 
patients. Scand J Trauma Resusc Emerg Med 
2018; 26(1): e102. doi: 10.1186/s13049-018-
0565-3
VREDNOTENJE SISTEMA OCENJEVANJA TRAVME IN POŠKODB ENDOTELIJSKEGA 
GLIKOKALIKSA PRI MAČKAH S POŠKODBO GLAVE
K. Parlak, A. Naseri, M. Yalcin, E. T. Akyol, M. Ok, M. Arican
Izvleček: Namen te študije je bil ovrednotiti spremenjeno glasgowsko lestvico kome (angl. Glasgow Coma Scale, GCS) in 
ocene ATT (Animal Trauma Triage), laboratorijske spremenljivke in prognostične značilnosti s travmo povzročene poškodbe 
endotelijskega glikokaliksa pri mačkah s poškodbo glave. V študijo je bilo vključenih 25 mačk s poškodbo glave in 10 zdravih 
mačk. Ravni sindekana-1 in trombomodulina v serumu 25 mačk s poškodbo glave (v 48 urah) in 10 zdravih mačk smo merili z 
encimsko imunoadsorpcijsko preiskavo (ELISA). Ocene mGCS, ocene ATT, laboratorijske vrednosti ter ravni sindekana-1 in 
trombomodulina smo primerjali med mačkami, ki so po zdravljenju preživele, in mačkami, ki kljub zdravljenju niso preživele. 
Vrednosti sindekana-1 in trombomodulina se med zdravimi mačkami in mačkami s poškodbo glave niso statistično razlikova-
le. Pri mačkah s poškodbo glave se je sistem točkovanja mCGS izkazal za občutljivejšega od sistema točkovanja ATT. Zaklju-
čili smo, da vrednosti sindekana-1 in trombomodulina pri mačkah s poškodbo glave niso statistično pomembne. 
Ključne besede: triaža poškodb živali; mačka; poškodba glave; spremenjena glasgowska lestvica kome; endotelijski 
glikokaliks