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

Autor: Felix Chua, Ailsa Hart, James O. Lindsay, Mark A Samaan, Susanna Meade, Ian D. Arnott, Kamal V. Patel, Tim Raine, Richard Hansen, R Mark Beattie, Richard Pollok, Shahida Din, Phil Tozer, Laura Hancock, Subrata Ghosh, Andrew Ustianowski, Rachel Cooney, Daniel R. Gaya, Peter M. Irving, Lisa Younge, Shaji Sebastian, Christian P. Selinger, Jimmy K. Limdi, Charles Murray, Chris Probert, Christopher A. Lamb, Alexandra Kent, Philip J Smith, Nick Powell, Mark J.D. Griffiths, James Galloway, Nicholas A. Kennedy, Robin J. Dart, Charlie W. Lees
Přispěvatelé: Din, Shahida [0000-0003-2855-3400], Kent, Alexandra [0000-0003-0577-6177], Pollok, Richard C [0000-0001-6452-6763], Meade, Susanna [0000-0002-8283-6148], Kennedy, Nicholas A [0000-0003-4368-1961], Arnott, Ian [0000-0003-3352-9253], Beattie, R Mark [0000-0003-4721-0577], Chua, Felix [0000-0001-7845-0173], Cooney, Rachel [0000-0003-3710-157X], Dart, Robin J [0000-0003-3470-8210], Galloway, James [0000-0002-1230-2781], Gaya, Daniel R [0000-0003-1942-7568], Ghosh, Subrata [0000-0002-1713-7797], Griffiths, Mark [0000-0002-1615-1896], Hancock, Laura [0000-0002-8399-6646], Hansen, Richard [0000-0002-3944-6646], Hart, Ailsa [0000-0002-7141-6076], Lamb, Christopher Andrew [0000-0002-7271-4956], Lees, Charlie W [0000-0002-0732-8215], Limdi, Jimmy K [0000-0002-1039-6251], Lindsay, James O [0000-0003-3353-9590], Patel, Kamal [0000-0003-2611-4260], Powell, Nick [0000-0003-3231-6950], Murray, Charles D [0000-0001-6736-1546], Probert, Chris [0000-0003-0477-6714], Raine, Tim [0000-0002-5855-9873], Selinger, Christian [0000-0003-2022-5859], Sebastian, Shaji [0000-0002-3670-6545], Smith, Philip J [0000-0003-1568-3978], Tozer, Phil [0000-0002-2532-7267], Younge, Lisa [0000-0002-3436-9696], Samaan, Mark A [0000-0002-4057-9200], Irving, Peter M [0000-0003-0972-8148], Apollo - University of Cambridge Repository
Rok vydání: 2020
Předmět:
medicine.medical_specialty
medicine.medical_treatment
Pneumonia
Viral
Psychological intervention
Context (language use)
Infection Control/organization & administration
clinical decision making
Gastroenterology
Inflammatory bowel disease
Colitis
Ulcerative/diagnosis
03 medical and health sciences
Betacoronavirus
0302 clinical medicine
Maintenance therapy
Internal medicine
Medicine
Humans
030212 general & internal medicine
Pandemics/prevention & control
Pneumonia
Viral/epidemiology
Pandemics
Societies
Medical
Colectomy
ulcerative colitis
Infection Control
business.industry
SARS-CoV-2
Patient Selection
COVID-19
Guideline
medicine.disease
Ulcerative colitis
Infliximab
United Kingdom
Pneumonia
IBD clinical
Acute Disease
Practice Guidelines as Topic
Coronavirus Infections/epidemiology
030211 gastroenterology & hepatology
Colitis
Ulcerative
business
Coronavirus Infections
medicine.drug
Zdroj: Gut
GUT
Din, S, Kent, A, Pollok, R C, Meade, S, Kennedy, N A, Arnott, I, Beattie, R M, 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 the context of the COVID-19 pandemic : a RAND appropriateness panel ', Gut, vol. 69, no. 10, pp. 1769-1777 . https://doi.org/10.1136/gutjnl-2020-321927
ISSN: 1468-3288
Popis: ObjectiveManagement 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.DesignWe 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.ResultsPanellists 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.ConclusionWe have suggested COVID-19-specific adaptations to the BSG ASUC guideline using a RAND panel.
Databáze: OpenAIRE
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