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Contemporary Outcomes for Ulcerative Colitis Inpatients Admitted to Pediatric Hospitals in the United Kingdom

Russell, Richard K. MRCPCH, PhD1; Protheroe, Aimee BSc2; Roughton, Michael MSc, BSc2; Croft, Nick M. PhD, FRCPCH3; Murphy, M. Stephen FRCPI, FRCPCH4; Spray, Christine MB ChB, FRCPCH5; Rodrigues, Astor F. MRCPCH, MD6; Wilson, David C. MD, FRCPCH7; Puntis, John FRCP, FRCPCH8; Cosgrove, Mike BM BS, FRCPCH9; Tamok, Andras MD, PhD10; Rao, Prithviraj MBBS, DNB, MRCPCH11; Down, Calvin BA2; Arnott, Ian D. R. MD, FRCP12; Mitton, Sally G. MD, FRCPCH13

doi: 10.1097/MIB.0b013e31828133d6
Original Clinical Article

Background: Pediatric ulcerative colitis (UC) care is variable with a lack of appropriate guidelines to guide practice until recently.

Methods: UC inpatients <17 years old admitted to 23 U.K. pediatric hospitals had clinical details collected between September 2010 and 2011. Comparative data for 248 patients were available from a previous audit in 2008.

Results: One hundred and seventy-six patients (98 males) of median age 13 years (interquartile range, 10–13) were analyzed; 23 were elective surgical admissions, 47 new diagnoses, and 106 needed acute medical care for established UC. Median length of stay was 6 days (interquartile range, 3–10) with no deaths. Eighty-eight of 126 patients (70%) with active disease had standard stool cultures performed (3 [2%] were positive), and 57 (45%) had Clostridium difficile toxin tested (none positive). Twenty-five of 66 (38%) emergency admissions had an abdominal x-ray on admission, and 13 of 66 patients (20%) had a Pediatric Ulcerative Colitis Activity Index score. There were 3 cases of toxic megacolon and 2 thromboses. Eighty-one of 116 patients (71%) responded to steroids. Nineteen patients who did not respond adequately to steroids received rescue therapy (7 infliximab, 11 ciclosporin, and 1 both) with overall response rate of 90%; 7 patients needed surgery acutely, 5 without previous rescue therapy. Compared with the 2008 data, stool culture rates improved significantly (86 of 121 [71%] versus 76 of 147 [52%], P = 0.001) as did heparinization rates (15 of 150 [10%] versus 5 of 215 [2%], P = 0.002) and rescue therapy usage (17 of 33 [52%] versus 10 of 38 [26%], P = 0.03).

Conclusions: There were signs of improving UC care with significantly increased rates of stool culture and rescue therapy. The majority of sites, however, did not use Pediatric Ulcerative Colitis Activity Index scores.

Article first published online 24 April 2013

1Department of Paediatric Gastroenterology, Yorkhill Hospital, Glasgow, United Kingdom;

2Clinical Effectiveness and Evaluation unit (CEEu), Royal College of Physicians of London, London, United Kingdom;

3Centre for Gastroenterology, Blizard Institute, Bart’s and the London, Queen Mary’s School of Medicine, London, United Kingdom;

4Institute of Child Health, College of Clinical & Experimental Medicine, School of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom;

5Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom;

6Department of Paediatric Gastroenterology, Oxford Children’s Hospitals, Headley Way, Headington, Oxford, United Kingdom;

7Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom;

8Department of Paediatric Gastroenterology, the General Infirmary at Leeds, Leeds, United Kingdom;

9Department of Paediatrics, Singleton Hospital, Swansea, United Kingdom;

10Department of Paediatric Gastroenterology, The Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom;

11Department of Paediatric Gastroenterology, Sheffield Children's Hospital,Sheffield, United Kingdom;

12Gastrointestinal Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom; and

13Department of Paediatric Gastroenterology, St Georges Hospital, London, United Kingdom.

Reprints: Richard K. Russell, MRCPCH, PhD, Department of Paediatric Gastroenterology, Yorkhill Hospital, Dalnair Street, Glasgow G3 8SJ, United Kingdom (e-mail: richardrussell@nhs.net).

The IBD team at Yorkhill Hospital Glasgow are supported by the Catherine McEwan Foundation and Yorkhill IBD fund. R. K. Russell is supported by an NHS Research Scotland career fellowship award. For data collection, Lucy Howarth (Oxford), Harween Dogra (Barts and the London), Saurabh Patwardhan/Kausik Khan (Swansea), and Elizabeth Waddington (Leeds).

R. K. Russell has received consultation fees, research grants, or honorarium from MSD, Abbott, Dr Falk, Ferring, and Nestle. D. C. Wilson has received consultation fees, speaker’s fees, or honoraria from MSD, Abbott, Ferring, and Nestle. A. F. Rodrigues has received sponsorship/honorarium from Mead Johnson and SMA Pfizer Nutrition. N. M. Croft has received consultation fees, research grants, or honorarium from MSD, Abbott, Dr Falk, and Ferring.

Some data have been published previously in the form of a report produced for sites participating in the audit as a local and national report made available by the Clinical Effectiveness and Evaluation unit of the Royal College of Physicians of London. A very limited number of data items have also been published in the public domain.

Received September 04, 2012

Accepted September 24, 2012

© Crohn's & Colitis Foundation of America, Inc.
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