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
| 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 |
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| Authors: | Din, Shahida; Kent, Alexandra; Pollok, Richard C.; Meade, Susanna; Kennedy, Nicholas A.; Arnott, Ian; Mark Beattie, R.; 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. |
| Source: | Din, S, Kent, A, Pollok, R C, Meade, S, Kennedy, N A, Arnott, I, Mark Beattie, R, Chua, F, Cooney, R, Dart, R J, Galloway, J, Gaya, D R, Ghosh, S, Griffiths, M, Hancock, L, Hansen, R, Hart, A, Lamb, C A, Lees, C W, Limdi, J K, Lindsay, J O, Patel, K, Powell, N, Murray, C D, Probert, C, Raine, T, Selinger, C, Sebastian, S, Smith, P J, Tozer, P, Ustianowski, A, Younge, L, Samaan, M A & Irving, P M 2020, 'Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in .... |
| Publication Year: | 2020 |
| Collection: | Discovery - University of Dundee Online Publications |
| Subject Terms: | clinical decision making; IBD clinical; ulcerative colitis; /dk/atira/pure/subjectarea/asjc/2700/2715; name=Gastroenterology |
| 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: | 0017-5749; 1468-3288 |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/32513653; info:eu-repo/semantics/altIdentifier/pissn/0017-5749; info:eu-repo/semantics/altIdentifier/eissn/1468-3288 |
| DOI: | 10.1136/gutjnl-2020-321927 |
| Availability: | https://discovery.dundee.ac.uk/en/publications/b4058b85-99fc-4ae3-9923-a8283aa70033; https://doi.org/10.1136/gutjnl-2020-321927; https://discovery.dundee.ac.uk/ws/files/100853973/1769.full.pdf; https://www.scopus.com/pages/publications/85090121195 |
| Rights: | info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: | edsbas.D91DACF6 |
| Database: | BASE |