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

TY - JOUR

T1 - Adaptations to the British Society of Gastroenterology guidelines on the management of acute severe UC in the context of the COVID-19 pandemic

T2 - A RAND appropriateness panel

AU - Din, Shahida

AU - Kent, Alexandra

AU - Pollok, Richard C.

AU - Meade, Susanna

AU - Kennedy, Nicholas A.

AU - Arnott, Ian

AU - Mark Beattie, R.

AU - Chua, Felix

AU - Cooney, Rachel

AU - Dart, Robin J.

AU - Galloway, James

AU - Gaya, Daniel R.

AU - Ghosh, Subrata

AU - Griffiths, Mark

AU - Hancock, Laura

AU - Hansen, Richard

AU - Hart, Ailsa

AU - Lamb, Christopher Andrew

AU - Lees, Charlie W.

AU - Limdi, Jimmy K.

AU - Lindsay, James O.

AU - Patel, Kamal

AU - Powell, Nick

AU - Murray, Charles D.

AU - Probert, Chris

AU - Raine, Tim

AU - Selinger, Christian

AU - Sebastian, Shaji

AU - Smith, Philip J.

AU - Tozer, Phil

AU - Ustianowski, Andrew

AU - Younge, Lisa

AU - Samaan, Mark A.

AU - Irving, Peter M.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - 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.

AB - 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.

KW - clinical decision making

KW - IBD clinical

KW - ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85090121195&partnerID=8YFLogxK

U2 - 10.1136/gutjnl-2020-321927

DO - 10.1136/gutjnl-2020-321927

M3 - Article

C2 - 32513653

AN - SCOPUS:85090121195

SN - 0017-5749

VL - 69

SP - 1769

EP - 1777

JO - Gut

JF - Gut

IS - 10

ER -