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.

Bacteria Immunology Nutrition Gastroenterology and Omics Group University of Glasgow Glasgow UK

Blizard Institute Barts and the London School of Medicine Queen Mary University of London London UK

Cambridge Colorectal Unit Addenbrooke's Hospital Cambridge UK

CHEO IBD Centre Children's Hospital of Eastern Ontario Ottawa ON Canada

Child Life and Health University of Edinburgh Edinburgh UK

Department of Gastroenterology Guy's and St Thomas' NHS Foundation Trust London UK

Department of Gastroenterology Guy's and St Thomas' NHS Foundation Trust LondonUK

Department of Paediatric Gastroenterology Addenbrooke's Hospital Cambridge UK

Department of Paediatric Gastroenterology and Nutrition Royal Hospital for Children and Young People Edinburgh UK

Department of Paediatric Gastroenterology Evelina London Children's Hospital London UK

Department of Paediatric Gastroenterology Royal Hospital for Children Glasgow UK

Department of Paediatric Surgery Royal Hospital for Children Glasgow UK

Department of Paediatrics Centro Hospitalar São João Porto Portugal

Department of Paediatrics University Hospital Motol Prague Czech Republic

Department of Pediatric Gastroenterology Hepatology and Nutrition Hospital Sant Joan de Déu Barcelona Spain

Department of Pediatrics University of Ottawa Ottawa ON Canada

Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center Hebrew University of Jerusalem Jerusalem Israel

Paediatric Gastroenterology Royal London Children's Hospital Barts Health NHS Trust London UK

Pediatric Gastroenterology Department Erasmus MC Sophia Children Hospital Rotterdam The Netherlands

Pediatric Hematology Department Erasmus MC Sophia Children Hospital Rotterdam The Netherlands

School of Immunology and Microbial Sciences King's College London London UK

SickKids Inflammatory Bowel Disease Centre Hospital for Sick Children; Child Health Evaluative Sciences SickKids Research Institute; ICES; Department of Paediatrics and Institute of Health Policy Management and Evaluation University of Toronto Toronto ON Canada

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