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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

Research output: Contribution to journalArticle

Shahida Din, Alexandra Kent, Richard C. Pollok, Susanna Meade, Nicholas A. Kennedy, Ian Arnott, R. Mark Beattie, Felix Chua, Rachel Cooney, Robin J. Dart, James Galloway, Daniel R. Gaya, Subrata Ghosh, Mark Griffiths, Laura Hancock, Richard Hansen, Ailsa Hart, Christopher Andrew Lamb, Charlie W. Lees, Jimmy K. Limdi & 14 more James O. Lindsay, Kamal Patel, Nick Powell, Charles D. Murray, Chris Probert, Tim Raine, Christian Selinger, Shaji Sebastian, Philip J. Smith, Phil Tozer, Andrew Ustianowski, Lisa Younge, Mark A. Samaan, Peter M. Irving

Original languageEnglish
Pages (from-to)1769-1777
Number of pages9
JournalGut
Volume69
Issue number10
DOIs
Published1 Oct 2020

King's Authors

Abstract

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.

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