Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel

Franco Torrente; Susanna Meade; Eric I Benchimol; Lissy de Ridder; Nicholas M. Croft; Jochen Kammermeier; David R Mack; Renz C W Klomberg; Dan Turner; David C. Wilson; Javier Martín-de-Carpi; Jiri Bronsky; Jorge Amil Dias; Gregor Walker; C Heleen van Ommen; Michael P Powar; Natasha Burgess; Peter M. Irving; Mark A Samaan; Richard Hansen

doi:10.1093/ecco-jcc/jjac073

Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel

Franco Torrente, Susanna Meade, Eric I Benchimol, Lissy de Ridder, Nicholas M. Croft, Jochen Kammermeier, David R Mack, Renz C W Klomberg, Dan Turner, David C. Wilson, Javier Martín-de-Carpi, Jiri Bronsky, Jorge Amil Dias, Gregor Walker, C Heleen van Ommen, Michael P Powar, Natasha Burgess, Peter M. Irving, Mark A Samaan, Richard Hansen (Lead / Corresponding author)

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Abstract

Background and Aims: Thromboprophylaxis use in paediatric inflammatory bowel disease [IBD] is inconsistent. Current guidelines only support treating children with acute severe colitis with risk factors. We convened an international RAND panel to explore thromboprophylaxis in paediatric IBD inpatients in the context of new evidence.

Methods: We convened a geographically diverse 14-person panel of paediatric gastroenterologists alongside supporting experts. An online survey was sent before an online meeting. Panellists were asked to rate the appropriateness of thromboprophylaxis in hospitalised paediatric IBD patients via 27 scenarios of varying ages, gender, and phenotype, with and without thrombotic risk factors. Anonymised results were presented at the meeting. A second modified survey was distributed to all panellists present at the meeting. Results from the second survey constitute the RAND panel results. The validated RAND disagreement index defined disagreement when ≥ 1.

Results: The combined outcome of thromboprophylaxis being considered appropriate until discharge and inappropriate to withhold was seen in 20 of 27 scenarios, including: all patients with new-onset acute severe colitis; all flares of known ulcerative colitis, irrespective of risk factors except in pre-pubescent patients with limited disease and no risk factors; and all Crohn’s patients with risk factors. Disagreement was seen in five scenarios regarding Crohn’s without risk factors, where outcomes were already uncertain.

Conclusions: RAND panels are an established method to assess expert opinion in areas of limited evidence. This work therefore constitutes neither a guideline nor a consensus; however, the findings suggest a need to re-evaluate the role of thromboprophylaxis in future guidelines.

Original language	English
Pages (from-to)	1609–1616
Number of pages	8
Journal	Journal of Crohn's and Colitis
Volume	16
Issue number	10
Early online date	24 May 2022
DOIs	https://doi.org/10.1093/ecco-jcc/jjac073
Publication status	Published - Oct 2022

Keywords

Paediatric gastroenterology
ulcerative colitis
inflammatory bowel disease

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Torrente, F., Meade, S., Benchimol, E. I., de Ridder, L., Croft, N. M., Kammermeier, J., Mack, D. R., Klomberg, R. C. W., Turner, D., Wilson, D. C., Martín-de-Carpi, J., Bronsky, J., Dias, J. A., Walker, G., van Ommen, C. H., Powar, M. P., Burgess, N., Irving, P. M., Samaan, M. A., & Hansen, R. (2022). Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel. Journal of Crohn's and Colitis, 16(10), 1609–1616. https://doi.org/10.1093/ecco-jcc/jjac073

@article{11655157442d473b8639f4256375345e,

title = "Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel",

abstract = "Background and Aims: Thromboprophylaxis use in paediatric inflammatory bowel disease [IBD] is inconsistent. Current guidelines only support treating children with acute severe colitis with risk factors. We convened an international RAND panel to explore thromboprophylaxis in paediatric IBD inpatients in the context of new evidence.Methods: We convened a geographically diverse 14-person panel of paediatric gastroenterologists alongside supporting experts. An online survey was sent before an online meeting. Panellists were asked to rate the appropriateness of thromboprophylaxis in hospitalised paediatric IBD patients via 27 scenarios of varying ages, gender, and phenotype, with and without thrombotic risk factors. Anonymised results were presented at the meeting. A second modified survey was distributed to all panellists present at the meeting. Results from the second survey constitute the RAND panel results. The validated RAND disagreement index defined disagreement when ≥ 1.Results: The combined outcome of thromboprophylaxis being considered appropriate until discharge and inappropriate to withhold was seen in 20 of 27 scenarios, including: all patients with new-onset acute severe colitis; all flares of known ulcerative colitis, irrespective of risk factors except in pre-pubescent patients with limited disease and no risk factors; and all Crohn{\textquoteright}s patients with risk factors. Disagreement was seen in five scenarios regarding Crohn{\textquoteright}s without risk factors, where outcomes were already uncertain.Conclusions: RAND panels are an established method to assess expert opinion in areas of limited evidence. This work therefore constitutes neither a guideline nor a consensus; however, the findings suggest a need to re-evaluate the role of thromboprophylaxis in future guidelines.",

keywords = "Paediatric gastroenterology, ulcerative colitis, inflammatory bowel disease",

author = "Franco Torrente and Susanna Meade and Benchimol, {Eric I} and {de Ridder}, Lissy and Croft, {Nicholas M.} and Jochen Kammermeier and Mack, {David R} and Klomberg, {Renz C W} and Dan Turner and Wilson, {David C.} and Javier Mart{\'i}n-de-Carpi and Jiri Bronsky and Dias, {Jorge Amil} and Gregor Walker and {van Ommen}, {C Heleen} and Powar, {Michael P} and Natasha Burgess and Irving, {Peter M.} and Samaan, {Mark A} and Richard Hansen",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn{\textquoteright}s and Colitis Organisation. RH is supported by an NHS Research Scotland Career Researcher Fellowship. EB holds the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, the Hospital for Sick Children, and the SickKids Foundation. DRM receives support through a Distinguished Clinical Research Chair in Pediatric IBD from the Faculty of Medicine, University of Ottawa.",

year = "2022",

month = oct,

doi = "10.1093/ecco-jcc/jjac073",

language = "English",

volume = "16",

pages = "1609–1616",

journal = "Journal of Crohn's and Colitis",

issn = "1873-9946",

publisher = "Oxford University Press",

number = "10",

}

Torrente, F, Meade, S, Benchimol, EI, de Ridder, L, Croft, NM, Kammermeier, J, Mack, DR, Klomberg, RCW, Turner, D, Wilson, DC, Martín-de-Carpi, J, Bronsky, J, Dias, JA, Walker, G, van Ommen, CH, Powar, MP, Burgess, N, Irving, PM, Samaan, MA & Hansen, R 2022, 'Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel', Journal of Crohn's and Colitis, vol. 16, no. 10, pp. 1609–1616. https://doi.org/10.1093/ecco-jcc/jjac073

TY - JOUR

T1 - Thromboprophylaxis use in paediatric inflammatory bowel disease

T2 - an international RAND appropriateness panel

AU - Torrente, Franco

AU - Meade, Susanna

AU - Benchimol, Eric I

AU - de Ridder, Lissy

AU - Croft, Nicholas M.

AU - Kammermeier, Jochen

AU - Mack, David R

AU - Klomberg, Renz C W

AU - Turner, Dan

AU - Wilson, David C.

AU - Martín-de-Carpi, Javier

AU - Bronsky, Jiri

AU - Dias, Jorge Amil

AU - Walker, Gregor

AU - van Ommen, C Heleen

AU - Powar, Michael P

AU - Burgess, Natasha

AU - Irving, Peter M.

AU - Samaan, Mark A

AU - Hansen, Richard

N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. RH is supported by an NHS Research Scotland Career Researcher Fellowship. EB holds the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, the Hospital for Sick Children, and the SickKids Foundation. DRM receives support through a Distinguished Clinical Research Chair in Pediatric IBD from the Faculty of Medicine, University of Ottawa.

PY - 2022/10

Y1 - 2022/10

N2 - Background and Aims: Thromboprophylaxis use in paediatric inflammatory bowel disease [IBD] is inconsistent. Current guidelines only support treating children with acute severe colitis with risk factors. We convened an international RAND panel to explore thromboprophylaxis in paediatric IBD inpatients in the context of new evidence.Methods: We convened a geographically diverse 14-person panel of paediatric gastroenterologists alongside supporting experts. An online survey was sent before an online meeting. Panellists were asked to rate the appropriateness of thromboprophylaxis in hospitalised paediatric IBD patients via 27 scenarios of varying ages, gender, and phenotype, with and without thrombotic risk factors. Anonymised results were presented at the meeting. A second modified survey was distributed to all panellists present at the meeting. Results from the second survey constitute the RAND panel results. The validated RAND disagreement index defined disagreement when ≥ 1.Results: The combined outcome of thromboprophylaxis being considered appropriate until discharge and inappropriate to withhold was seen in 20 of 27 scenarios, including: all patients with new-onset acute severe colitis; all flares of known ulcerative colitis, irrespective of risk factors except in pre-pubescent patients with limited disease and no risk factors; and all Crohn’s patients with risk factors. Disagreement was seen in five scenarios regarding Crohn’s without risk factors, where outcomes were already uncertain.Conclusions: RAND panels are an established method to assess expert opinion in areas of limited evidence. This work therefore constitutes neither a guideline nor a consensus; however, the findings suggest a need to re-evaluate the role of thromboprophylaxis in future guidelines.

AB - Background and Aims: Thromboprophylaxis use in paediatric inflammatory bowel disease [IBD] is inconsistent. Current guidelines only support treating children with acute severe colitis with risk factors. We convened an international RAND panel to explore thromboprophylaxis in paediatric IBD inpatients in the context of new evidence.Methods: We convened a geographically diverse 14-person panel of paediatric gastroenterologists alongside supporting experts. An online survey was sent before an online meeting. Panellists were asked to rate the appropriateness of thromboprophylaxis in hospitalised paediatric IBD patients via 27 scenarios of varying ages, gender, and phenotype, with and without thrombotic risk factors. Anonymised results were presented at the meeting. A second modified survey was distributed to all panellists present at the meeting. Results from the second survey constitute the RAND panel results. The validated RAND disagreement index defined disagreement when ≥ 1.Results: The combined outcome of thromboprophylaxis being considered appropriate until discharge and inappropriate to withhold was seen in 20 of 27 scenarios, including: all patients with new-onset acute severe colitis; all flares of known ulcerative colitis, irrespective of risk factors except in pre-pubescent patients with limited disease and no risk factors; and all Crohn’s patients with risk factors. Disagreement was seen in five scenarios regarding Crohn’s without risk factors, where outcomes were already uncertain.Conclusions: RAND panels are an established method to assess expert opinion in areas of limited evidence. This work therefore constitutes neither a guideline nor a consensus; however, the findings suggest a need to re-evaluate the role of thromboprophylaxis in future guidelines.

KW - Paediatric gastroenterology

KW - ulcerative colitis

KW - inflammatory bowel disease

U2 - 10.1093/ecco-jcc/jjac073

DO - 10.1093/ecco-jcc/jjac073

M3 - Article

C2 - 35608932

SN - 1873-9946

VL - 16

SP - 1609

EP - 1616

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

IS - 10

ER -

Thromboprophylaxis use in paediatric inflammatory bowel disease: an international RAND appropriateness panel

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