Thromboprophylaxis Use in Paediatric Inflammatory Bowel Disease: An International RAND Appropriateness Panel.
Franco Torrente1, Susanna Meade2, Eric I Benchimol3
1Department of Paediatric Gastroenterology, Addenbrooke's Hospital, Cambridge, UK.
Journal of Crohn'S & Colitis
|May 24, 2022
Summary
Thromboprophylaxis is recommended for most hospitalized pediatric inflammatory bowel disease (IBD) patients, especially those with severe colitis or Crohn's disease risk factors. New evidence suggests re-evaluating current guidelines for pediatric IBD thromboprophylaxis.
Area of Science:
- Pediatric Gastroenterology
- Thrombosis Prevention
- Inflammatory Bowel Disease
Background:
- Thromboprophylaxis use in pediatric inflammatory bowel disease (IBD) is inconsistent.
- Current guidelines recommend prophylaxis only for children with acute severe colitis and risk factors.
- New evidence necessitates re-evaluation of thromboprophylaxis in hospitalized pediatric IBD patients.
Purpose of the Study:
- To explore expert opinion on thromboprophylaxis appropriateness in hospitalized pediatric IBD patients.
- To assess the impact of varying clinical factors on thromboprophylaxis recommendations.
- To inform potential revisions of current guidelines for pediatric IBD management.
Main Methods:
- Convened a 14-person international RAND panel of pediatric gastroenterologists and experts.
- Utilized a two-round online survey assessing 27 clinical scenarios.
- Applied the RAND disagreement index to identify areas of expert consensus and uncertainty.
Main Results:
- Thromboprophylaxis was deemed appropriate in 20 of 27 scenarios.
- Recommendations included all new-onset acute severe colitis, most ulcerative colitis flares, and Crohn's patients with risk factors.
- Disagreement persisted in scenarios involving Crohn's disease without risk factors.
Conclusions:
- RAND panels provide valuable insights into expert opinion for evidence-limited areas.
- Findings suggest a need to reconsider the role of thromboprophylaxis in pediatric IBD guidelines.
- This study highlights areas requiring further investigation and potential guideline updates.
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