| Title: |
Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic: a RAND appropriateness panel |
| Authors: |
Din, Shahida; Kent, Alexandra; Pollok, Richard C; Meade, Susanna; Kennedy, Nicholas A; Arnott, Ian; Beattie, R Mark; Chua, Felix; Cooney, Rachel; Dart, Robin J; Galloway, James; Gaya, Daniel R; Ghosh, Subrata; Griffiths, Mark; Hancock, Laura; Hansen, Richard; Hart, Ailsa; Lamb, Christopher Andrew; Lees, Charlie W; Limdi, Jimmy K; Lindsay, James O; Patel, Kamal; Powell, Nick; Murray, Charles D; Probert, Chris; Raine, Tim; Selinger, Christian; Sebastian, Shaji; Smith, Philip J; Tozer, Phil; Ustianowski, Andrew; Younge, Lisa; Samaan, Mark A; Irving, Peter M |
| Publisher Information: |
BMJ Publishing Group; Gut |
| Publication Year: |
2020 |
| Collection: |
Apollo - University of Cambridge Repository |
| Subject Terms: |
Inflammatory bowel disease; ulcerative colitis; clinical decision making; IBD clinical |
| Time: |
1506; 2474; 2312 |
| Description: |
Objective: Management of acute severe UC (ASUC) during the novel COVID-19 pandemic presents significant dilemmas. We aimed to provide COVID-19-specific guidance using current British Society of Gastroenterology (BSG) guidelines as a reference point. Design: We convened a RAND appropriateness panel comprising 14 gastroenterologists and an IBD nurse consultant supplemented by surgical and COVID-19 experts. Panellists rated the appropriateness of interventions for ASUC in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Median scores and disagreement index (DI) were calculated. Results were discussed at a moderated meeting prior to a second survey. Results: Panellists recommended that patients with ASUC should be isolated throughout their hospital stay and should have a SARS-CoV-2 swab performed on admission. Patients with a positive swab should be discussed with COVID-19 specialists. As per BSG guidance, intravenous hydrocortisone was considered appropriate as initial management; only in patients with COVID-19 pneumonia was its use deemed uncertain. In patients requiring rescue therapy, infliximab with continuing steroids was recommended. Delaying colectomy because of COVID-19 was deemed inappropriate. Steroid tapering as per BSG guidance was deemed appropriate for all patients apart from those with COVID-19 pneumonia in whom a 4–6 week taper was preferred. Post-ASUC maintenance therapy was dependent on SARS-CoV-2 status but, in general, biologics were more likely to be deemed appropriate than azathioprine or tofacitinib. Panellists deemed prophylactic anticoagulation postdischarge to be appropriate in patients with a positive SARS-CoV-2 swab. Conclusion: We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf; text/xml |
| Language: |
English |
| Relation: |
https://www.repository.cam.ac.uk/handle/1810/307039 |
| DOI: |
10.17863/CAM.54134 |
| Availability: |
https://www.repository.cam.ac.uk/handle/1810/307039; https://doi.org/10.17863/CAM.54134 |
| Rights: |
Attribution 4.0 International (CC BY 4.0) ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.141F6AB7 |
| Database: |
BASE |