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



Din, Shahida, Kent, Alexandra, Pollok, Richard C, Meade, Susanna, Kennedy, Nicholas A, Arnott, Ian, Beattie, R Mark, Chua, Felix, Cooney, Rachel, Dart, Robin J
et al (show 24 more authors) (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.

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Abstract

<h4>Objective</h4>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.<h4>Design</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>We have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel.

Item Type: Article
Uncontrolled Keywords: ulcerative colitis, clinical decision making, IBD clinical
Depositing User: Symplectic Admin
Date Deposited: 01 Sep 2020 10:42
Last Modified: 18 Jan 2023 23:35
DOI: 10.1136/gutjnl-2020-321927
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3099548