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.
- ulcerative colitis
- clinical decision making
- IBD clinical
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SD, AK, RCP and SM are joint first authors.
Twitter @NA, @DrChrisLamb, @jklimdi
Correction notice This article has been corrected since it published Online First. ORCID ID's have been added, figure 1 replaced and text 'COVID swab' within tables replaced with 'SARS-CoV-2'
Contributors All authors approved the final version. Study concept and design: SD, AK, RCP, MAS, PMI. Development of questionnaire: SD, AK, RCP, SM, PMI, MAS, NK. Data analysis: PMI, MAS, SM. Interpretation of data and drafting of manuscript: SD, AK, RCP, SM, MAS, NK, PMI. Panellists, experts and moderators: SD, AK, RCP, SM, NK, JOL, CAL, JKL, CP, CS, SS, DRG, TR, RJD, AH, LY, CWL, IA, FC, JG, AU, MG, PT, LH, MAS, SM, PMI. Contributions to literature review and critical revision of the manuscript for important intellectual content: All authors.
Funding PMI is supported by a grant from the Medical Research Council [MR/T005564/1]
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.