Ambulatory care management of 69 patients with acute severe ulcerative colitis in comparison to 695 inpatients: Insights from a multicentre UK cohort study
Authors
Sebastian, ShajiPatel, Kamal V
Segal, Jonathan P
Subramanian, Sreedhar
Conley, Thomas E
Gonzalez, Haidee A
Kent, Alexandra J
Saifuddin, Aamir
Hicks, Lucy C
Mehta, Shameer J
Bhala, Neeraj
Brookes, Matthew J
Lamb, Christopher A
Kennedy, Nicholas A
PROTECT ASUC collaborators
Walker, Gareth J
Issue Date
2022-01-31
Metadata
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Introduction Acute severe ulcerative colitis (ASUC) traditionally requires inpatient hospital management for intravenous therapies and/or colectomy. Ambulatory ASUC care has not yet been evaluated in large cohorts. Aims We used data from PROTECT, a UK multicentre observational COVID-19 inflammatory bowel disease study, to report the extent, safety and effectiveness of ASUC ambulatory pathways. Methods Adults (≥18 years old) meeting Truelove and Witts criteria between 1 January 2019-1 June 2019 and 1 March 2020-30 June 2020 were recruited to PROTECT. We used demographic, disease phenotype, treatment outcomes and 3-month follow-up data. Primary outcome was rate of colectomy during the index ASUC episode. Secondary outcomes included corticosteroid response, time to and rate of rescue or primary induction therapy, response to rescue or primary induction therapy, time to colectomy, mortality, duration of inpatient treatment and hospital readmission and colectomy within 3 months of index flare. We compared outcomes in three cohorts: (1) patients treated entirely in inpatient setting; ambulatory patients subdivided into; (2) patients managed as ambulatory from diagnosis and (3) patients hospitalised and subsequently discharged to ambulatory care for continued intravenous steroids. Results 37% (22/60) participating hospitals used ambulatory pathways. Of 764 eligible patients, 695 (91%) patients received entirely inpatient care, 15 (2%) patients were managed as ambulatory from diagnosis and 54 (7%) patients were discharged to ambulatory pathways. Aside from younger age in patients treated as ambulatory from diagnosis, no significant differences in disease or patient phenotype were observed. The rate of colectomy (15.0% (104/695) vs 13.3% (2/15) vs 13.0% (7/54), respectively, p=0.96) and secondary outcomes were similar among all three cohorts. Stool culture and flexible sigmoidoscopy were less frequently performed in ambulatory cohorts. Forty per cent of patients treated as ambulatory from diagnosis required subsequent hospital admission. Conclusions In a post hoc analysis of one of the largest ASUC cohorts collected to date, we report an emerging UK ambulatory practice which challenges treatment paradigms. However, our analysis remains underpowered to detect key outcome measures and further studies exploring clinical and cost-effectiveness as well as patient and physician acceptability are needed. Trial registration number NCT04411784.Citation
Sebastian S, Patel KV, Segal JP, et alAmbulatory care management of 69 patients with acute severe ulcerative colitis in comparison to 695 inpatients: insights from a multicentre UK cohort study. BMJ Open Gastroenterology 2022;9:e000763. doi: 10.1136/bmjgast-2021-000763Publisher
BMJJournal
BMJ Open GastroenterologyPubMed ID
35101886 (pubmed)Additional Links
https://bmjopengastro.bmj.com/content/9/1/e000763Type
Journal articleLanguage
enDescription
© 2022 The Authors. Published by BMJ. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://bmjopengastro.bmj.com/content/9/1/e000763ISSN
2054-4774EISSN
2054-4774ae974a485f413a2113503eed53cd6c53
10.1136/bmjgast-2021-000763
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Except where otherwise noted, this item's license is described as Licence for published version: Creative Commons Attribution-NonCommercial 4.0 International
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