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 - Amil Dias, Jorge
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 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of European Crohn's and Colitis Organisation.
PY - 2022/10/1
Y1 - 2022/10/1
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 - inflammatory bowel disease
KW - ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=85141888531&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjac073
DO - 10.1093/ecco-jcc/jjac073
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C2 - 35608932
AN - SCOPUS:85141888531
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 -