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 journalArticlepeer-review

8 Citations (Scopus)


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 languageEnglish
Pages (from-to)1044-1052
Number of pages9
Issue number6
Early online date1 Sept 2020
Publication statusPublished - 7 May 2021


  • clinical decision making
  • inflammatory bowel disease
  • paediatric gastroenterology
  • ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology


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