| 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, S; Kent, A; Pollok, RC; Meade, S; Kennedy, NA; Arnott, I; Beattie, RM; Chua, F; Cooney, R; Dart, RJ; Galloway, J; Gaya, DR; Ghosh, S; Griffiths, M; Hancock, L; Hansen, R; Hart, A; Lamb, CA; Lees, CW; Limdi, JK; Lindsay, JO; Patel, K; Powell, N; Murray, CD; Probert, C; Raine, T; Selinger, C; Sebastian, S; Smith, PJ; Tozer, P; Ustianowski, A; Younge, L; Samaan, MA; Irving, PM |
| Publisher Information: |
BMJ Publishing Group |
| Publication Year: |
2020 |
| Collection: |
St George's University of London: Repository |
| 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 |
| Language: |
English |
| ISSN: |
1468-3288 |
| Relation: |
https://openaccess.sgul.ac.uk/id/eprint/112004/6/gutjnl-2020-321927.full.pdf; https://openaccess.sgul.ac.uk/id/eprint/112004/1/gutjnl-2020-321927.R1_Proof%20ASUC%20RAND.pdf; Din, S; Kent, A; Pollok, RC; Meade, S; Kennedy, NA; Arnott, I; Beattie, RM; Chua, F; Cooney, R; Dart, RJ; et al. Din, S; Kent, A; Pollok, RC; Meade, S; Kennedy, NA; Arnott, I; Beattie, RM; Chua, F; Cooney, R; Dart, RJ; Galloway, J; Gaya, DR; Ghosh, S; Griffiths, M; Hancock, L; Hansen, R; Hart, A; Lamb, CA; Lees, CW; Limdi, JK; Lindsay, JO; Patel, K; Powell, N; Murray, CD; Probert, C; Raine, T; Selinger, C; Sebastian, S; Smith, PJ; Tozer, P; Ustianowski, A; Younge, L; Samaan, MA; Irving, PM (2020) 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. Gut, 69 (10). pp. 1769-1777. ISSN 1468-3288 https://doi.org/10.1136/gutjnl-2020-321927 SGUL Authors: Pollok, Richard Charles G |
| Availability: |
https://openaccess.sgul.ac.uk/id/eprint/112004/ |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.704025F1 |
| Database: |
BASE |