ATT score beats VetCOT in cats with high-rise syndrome
Bottom line
Version 1
A new Journal of Small Animal Practice study suggests the Animal Trauma Triage Score, or ATT, is a better mortality predictor than the canine-derived VetCOT score for cats with high-rise syndrome. In the retrospective study, investigators at the Veterinary Teaching Hospital of the Catholic University of Valencia reviewed 60 cats that fell from height; eight cats, or 13%, did not survive to discharge. ATT showed significantly stronger prognostic performance than VetCOT on ROC analysis, with an AUC of 0.85 versus 0.709. Higher fall height, higher serum lactate, and vasopressor requirement were also associated with worse outcomes. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary teams triaging feline trauma, the study adds to a growing body of evidence that species-specific scoring tools may outperform systems adapted from dogs. Prior VetCOT registry work has already supported ATT use in injured cats, including a 3,859-cat analysis showing markedly lower survival in cats with higher ATT scores, while earlier high-rise syndrome research also found ATT to be a useful prognostic tool in this population. Together, the new findings strengthen the case for using ATT, rather than relying on canine-derived trauma scores, when making early risk assessments in cats after falls. (pubmed.ncbi.nlm.nih.gov)
What to watch: Watch for broader feline-specific validation studies, and for whether trauma centers and emergency teams begin favoring ATT over VetCOT in feline high-rise cases. (pubmed.ncbi.nlm.nih.gov)
Key facts
- Study type
- Retrospective study
- Population
- 60 cats with high-rise syndrome
- Outcome
- Eight cats, or 13%, did not survive to discharge
- Main finding
- ATT outperformed VetCOT for mortality prediction
- ATT AUC
- 0.85
- VetCOT AUC
- 0.709
- Publication date
- Published online July 2, 2026
- Associated worse outcomes
- Higher fall height, higher serum lactate, and vasopressor requirement
Version 2
Cats with high-rise syndrome may be better served by a feline-focused trauma score than by one borrowed from dogs. A new JSAP study published online July 2, 2026, found that the Animal Trauma Triage Score outperformed the Veterinary Committee on Trauma, or VetCOT, score for predicting mortality in 60 cats treated after falls from height. ATT achieved an AUC of 0.85, compared with 0.709 for VetCOT, and the difference was statistically significant. (pubmed.ncbi.nlm.nih.gov)
That finding fits with a longer shift in feline emergency medicine away from assuming canine tools translate cleanly to cats. The authors note that no trauma score has been developed exclusively from feline-derived data, and that existing systems are largely adapted from canine or mixed-species work. Earlier studies have already pushed the field in a more cat-specific direction: a prospective study in 25 cats with high-rise syndrome found ATT was significantly associated with mortality, and a large ACVECC VetCOT registry analysis helped validate ATT in injured cats more broadly. (pubmed.ncbi.nlm.nih.gov)
In the new study, researchers retrospectively evaluated admission variables including age, breed, sex, weight, body condition score, height of fall, clinicopathology, ATT, and VetCOT score, then compared those variables with mortality and length of stay. Eight of 60 cats did not survive to discharge. Beyond the scoring comparison, worse outcomes were associated with vasopressor requirement, greater fall height, higher serum lactate, and higher ATT. (pubmed.ncbi.nlm.nih.gov)
The broader literature helps explain why this matters clinically. Trauma-induced shock in cats can be difficult to recognize with conventional markers, and a 2026 prospective study in Animals highlighted the limitations of some standard shock indicators in feline patients while examining ATT alongside lactate and temperature gradients. Separate high-rise syndrome work published in 2024 also reported that ATT was good at predicting mortality, with an AUC of 0.857, and found that fall height and ground type were not accurate survival predictors on their own. (pubmed.ncbi.nlm.nih.gov)
Direct outside commentary on the new JSAP paper appears limited so far, but the trend line in published trauma research is fairly consistent. VetCOT registry publications and educational materials have continued to emphasize trauma scoring in cats, and recent feline trauma studies have repeatedly linked higher ATT scores with poorer outcomes. That doesn’t make ATT a standalone decision-maker, but it does suggest the score is becoming one of the more practical common languages for feline trauma severity across centers. This is an inference based on the pattern of published studies and VetCOT activity, rather than a formal guideline endorsement. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary professionals, especially ER and critical care teams, the takeaway is less about replacing clinical judgment and more about choosing the right framework at the right moment. High-rise cats often present with multisystem injury, shock, thoracic trauma, fractures, and occult internal damage. If ATT better reflects feline physiology and outcome risk than a canine-derived alternative, it could improve triage consistency, communication, and early prognostic discussions with pet parents, while also helping standardize case selection in future feline trauma research. (pubmed.ncbi.nlm.nih.gov)
The study also underscores a familiar issue in veterinary medicine: dogs still shape many emergency tools by default. As more feline-specific datasets emerge, scoring systems may become more precise for cats, whether through refinement of ATT thresholds or development of fully feline-native models. The current paper stops short of creating a new score, but it adds evidence that species-specific validation is not just academic housekeeping; it can change which patients are flagged as highest risk. (pubmed.ncbi.nlm.nih.gov)
What to watch: The next step is external validation in larger feline high-rise cohorts and, ideally, multicenter prospective work comparing ATT with other bedside markers such as lactate and shock parameters. Watch, too, for whether VetCOT-linked centers or emergency medicine groups incorporate these findings into training, registry analyses, or future clinical practice guidance. (pubmed.ncbi.nlm.nih.gov)