Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: A RAND appropriateness panel

Richard Hansen; Susanna Meade; R. Mark Beattie; Marcus K.H. Auth; Nick Croft; Philip Davies; David Devadason; Conor Doherty; Jenny Epstein; Lucy Howarth; Fevronia Kiparissi; Rafeeq Muhammed; Vinay Shivamurthy; Christine Spray; Michael P. Stanton; Franco Torrente; Arun Urs; David Wilson; Peter M. Irving; Mark Samaan; Jochen Kammermeier

doi:10.1136/gutjnl-2020-322449

Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: A RAND appropriateness panel

Richard Hansen, Susanna Meade, R. Mark Beattie, Marcus K.H. Auth, Nick Croft, Philip Davies, David Devadason, Conor Doherty, Jenny Epstein, Lucy Howarth, Fevronia Kiparissi, Rafeeq Muhammed, Vinay Shivamurthy, Christine Spray, Michael P. Stanton, Franco Torrente, Arun Urs, David Wilson, Peter M. Irving, Mark SamaanJochen Kammermeier

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Objective: Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison.

Design: We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic.

Results: were discussed at a moderated meeting prior to a second survey. Results Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19.

Conclusion: Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.

Original language	English
Pages (from-to)	1044-1052
Number of pages	9
Journal	Gut
Volume	70
Issue number	6
Early online date	1 Sept 2020
DOIs	https://doi.org/10.1136/gutjnl-2020-322449
Publication status	Published - 7 May 2021

Keywords

clinical decision making
inflammatory bowel disease
paediatric gastroenterology
ulcerative colitis

ASJC Scopus subject areas

Gastroenterology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/gutjnl-2020-322449

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Hansen, R., Meade, S., Beattie, R. M., Auth, M. K. H., Croft, N., Davies, P., Devadason, D., Doherty, C., Epstein, J., Howarth, L., Kiparissi, F., Muhammed, R., Shivamurthy, V., Spray, C., Stanton, M. P., Torrente, F., Urs, A., Wilson, D., Irving, P. M., ... Kammermeier, J. (2021). Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: A RAND appropriateness panel. Gut, 70(6), 1044-1052. https://doi.org/10.1136/gutjnl-2020-322449

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title = "Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: A RAND appropriateness panel",

abstract = "Objective: Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison. Design: We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results: were discussed at a moderated meeting prior to a second survey. Results Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19. Conclusion: Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.",

keywords = "clinical decision making, inflammatory bowel disease, paediatric gastroenterology, ulcerative colitis",

author = "Richard Hansen and Susanna Meade and Beattie, {R. Mark} and Auth, {Marcus K.H.} and Nick Croft and Philip Davies and David Devadason and Conor Doherty and Jenny Epstein and Lucy Howarth and Fevronia Kiparissi and Rafeeq Muhammed and Vinay Shivamurthy and Christine Spray and Stanton, {Michael P.} and Franco Torrente and Arun Urs and David Wilson and Irving, {Peter M.} and Mark Samaan and Jochen Kammermeier",

note = "Publisher Copyright: {\textcopyright} 2021 Author(s). Published by BMJ.",

year = "2021",

month = may,

day = "7",

doi = "10.1136/gutjnl-2020-322449",

language = "English",

volume = "70",

pages = "1044--1052",

journal = "Gut",

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number = "6",

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Hansen, R, Meade, S, Beattie, RM, Auth, MKH, Croft, N, Davies, P, Devadason, D, Doherty, C, Epstein, J, Howarth, L, Kiparissi, F, Muhammed, R, Shivamurthy, V, Spray, C, Stanton, MP, Torrente, F, Urs, A, Wilson, D, Irving, PM, Samaan, M & Kammermeier, J 2021, 'Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: A RAND appropriateness panel', Gut, vol. 70, no. 6, pp. 1044-1052. https://doi.org/10.1136/gutjnl-2020-322449

TY - JOUR

T1 - Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic

T2 - A RAND appropriateness panel

AU - Hansen, Richard

AU - Meade, Susanna

AU - Beattie, R. Mark

AU - Auth, Marcus K.H.

AU - Croft, Nick

AU - Davies, Philip

AU - Devadason, David

AU - Doherty, Conor

AU - Epstein, Jenny

AU - Howarth, Lucy

AU - Kiparissi, Fevronia

AU - Muhammed, Rafeeq

AU - Shivamurthy, Vinay

AU - Spray, Christine

AU - Stanton, Michael P.

AU - Torrente, Franco

AU - Urs, Arun

AU - Wilson, David

AU - Irving, Peter M.

AU - Samaan, Mark

AU - Kammermeier, Jochen

PY - 2021/5/7

Y1 - 2021/5/7

N2 - Objective: Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison. Design: We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results: were discussed at a moderated meeting prior to a second survey. Results Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19. Conclusion: Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.

AB - Objective: Paediatric acute severe colitis (ASC) management during the novel SARS-CoV-2/COVID-19 pandemic is challenging due to reliance on immunosuppression and the potential for surgery. We aimed to provide COVID-19-specific guidance using the European Crohn's and Colitis Organisation/European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for comparison. Design: We convened a RAND appropriateness panel comprising 14 paediatric gastroenterologists and paediatric experts in surgery, rheumatology, respiratory and infectious diseases. Panellists rated the appropriateness of interventions for ASC in the context of the COVID-19 pandemic. Results: were discussed at a moderated meeting prior to a second survey. Results Panellists recommended patients with ASC have a SARS-CoV-2 swab and expedited biological screening on admission and should be isolated. A positive swab should trigger discussion with a COVID-19 specialist. Sigmoidoscopy was recommended prior to escalation to second-line therapy or colectomy. Methylprednisolone was considered appropriate first-line management in all, including those with symptomatic COVID-19. Thromboprophylaxis was also recommended in all. In patients requiring second-line therapy, infliximab was considered appropriate irrespective of SARS-CoV-2 status. Delaying colectomy due to SARS-CoV-2 infection was considered inappropriate. Corticosteroid tapering over 8-10 weeks was deemed appropriate for all. After successful corticosteroid rescue, thiopurine maintenance was rated appropriate in patients with negative SARS-CoV-2 swab and asymptomatic patients with positive swab but uncertain in symptomatic COVID-19. Conclusion: Our COVID-19-specific adaptations to paediatric ASC guidelines using a RAND panel generally support existing recommendations, particularly the use of corticosteroids and escalation to infliximab, irrespective of SARS-CoV-2 status. Consideration of routine prophylactic anticoagulation was recommended.

KW - clinical decision making

KW - inflammatory bowel disease

KW - paediatric gastroenterology

KW - ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85092788384&partnerID=8YFLogxK

U2 - 10.1136/gutjnl-2020-322449

DO - 10.1136/gutjnl-2020-322449

M3 - Article

C2 - 32873696

SN - 0017-5749

VL - 70

SP - 1044

EP - 1052

JO - Gut

JF - Gut

IS - 6

ER -

Adaptations to the current ECCO/ESPGHAN guidelines on the management of paediatric acute severe colitis in the context of the COVID-19 pandemic: A RAND appropriateness panel

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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