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: a RAND appropriateness panel JF - Gut JO - Gut SP - 1769 LP - 1777 DO - 10.1136/gutjnl-2020-321927 VL - 69 IS - 10 AU - Shahida Din AU - Alexandra Kent AU - Richard C Pollok AU - Susanna Meade AU - Nicholas A Kennedy AU - Ian Arnott AU - R Mark Beattie AU - Felix Chua AU - Rachel Cooney AU - Robin J Dart AU - James Galloway AU - Daniel R Gaya AU - Subrata Ghosh AU - Mark Griffiths AU - Laura Hancock AU - Richard Hansen AU - Ailsa Hart AU - Christopher Andrew Lamb AU - Charlie W Lees AU - Jimmy K Limdi AU - James O Lindsay AU - Kamal Patel AU - Nick Powell AU - Charles D Murray AU - Chris Probert AU - Tim Raine AU - Christian Selinger AU - Shaji Sebastian AU - Philip J Smith AU - Phil Tozer AU - Andrew Ustianowski AU - Lisa Younge AU - Mark A Samaan AU - Peter M Irving Y1 - 2020/10/01 UR - http://gut.bmj.com/content/69/10/1769.abstract 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. ER -