Internet Archive Scholar

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

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 (+24 others)
2020

Preserved Fulltext

fulltext thumbnail
Web Archive Capture PDF (2.4 MB)
https://web.archive.org/web/20200626110838/https://www.repository.cam.ac.uk/bitstream/handle/1810/307039/gutjnl-2020-321927.pdf;jsessionid=8B39A9055133D0F25BDF278C63F0D2B8?sequence=2

A copy of this work was available on the public web and has been preserved in the Wayback Machine. The capture dates from 2020; you can also visit the original URL. The file type is application/pdf.

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
more » ... e 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.
doi:10.17863/cam.54134 fatcat:e7vk7rmtozbvflg35e2yswm52e
Citation

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, 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, Apollo-University Of Cambridge Repository, Apollo-University Of Cambridge Repository. "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." (2020)