ABSTRACT
BackgroundThe first wave of the COVID-19 pandemic in the UK severely restricted our regional paediatric GI outpatient services affecting our ability to assess patients in hospital, further compounded by distance of travel of patients (An audit form 2019 showed 70% of patients endoscoped were from outside the local, rather than Southampton area). The issue was further compounded by some DGH’s, who stopped offering the calprotectin test due to COVID-19 infection risk to the staff. Although home based calprotectin kits are also available, families using them have reported their use cumbersome and difficult to process tests at home. In addition, calprotectin results from other laboratories may be difficult to access. These limitations led to the development of a new regional service, in which samples taken at home are posted to the hub hospital laboratory (where the IBD clinic is based) for Calprotectin testing. AimTo study the benefits of offering a service for posting faecal samples for calprotectin testing to a hub laboratory.MethodsChildren (0–18 years) with IBD in the Wessex region, UK needing a calprotectin test were given postal faecal calprotectin packs (PFCP), either by hand in clinic or posted to their home. Each PFCP contained a labelled specimen bottle with immunology request form, bio-packaging box, sealable return bag (UN3373 compliant) with attached freepost label and instruction sheet. A Calprotectin cut off level of <200 was used as normal.Results63 patients (M=34, 54% & F=29, 46%) were given PFCP between 27th July & 5th of Nov 2020 with 52.4% posted PFCP and 47.6% given PFCP by hand in the paediatric GI clinic. The patients resided at a mean distance of 41.6 miles (1 SD = 24.1 miles) as the crow flies from the hospital. A mean of 25 days (1SD = 10 days) were taken from posting/handing of PFCP to the lab test result being obtained.The PFCP was returned by 50 patients (79.4% compliance) with a diagnosis of Crohn’s disease 34.9%, UC 28.6%, IBDU 7.9%, oral ulcers 4.8% and 23.8% of patients referred for endoscopy with IBD like symptoms. 30% of the patients with IBD (15/50) posting the PFCP had an abnormal test result. This led to a change in management in 40% of the patients. In the patient group referred with suspected IBD only 1/15 patients had an abnormal calprotectin test. 70% of patients with a normal test were able to be reassured without further investigation. ConclusionThis is the first reported series, offering to a large region a robust method for samples to be taken at home and posted to a central hub laboratory for calprotectin testing during the COVID-19 pandemic. Test results were readily available, being performed in the same hospital site as the IBD clinic. Compliance with the new PFCP remains high with 80% using the new PFCP service, with value in early identification of patients who may not have much in terms of symptoms and avoidance of endoscopy in others with a normal calprotectin.