Adherence to guideline-recommended management in acute severe ulcerative colitis: a retrospective audit

Background Acute severe ulcerative colitis (ASUC) is a life-threatening complication of ulcerative colitis that requires hospitalization and prompt guideline-directed management. We evaluated adherence to recommended inpatient management in hospitalized patients with ASUC.Methods We conducted a single-center retrospective audit of patients hospitalized with ASUC at a tertiary care center from 2014 to 2024. ASUC was defined using Truelove and Witts’ criteria. Patients <18 years were excluded. The primary outcome was venous thromboembolism (VTE) prophylaxis. Secondary outcomes included Clostridioides difficile and cytomegalovirus (CMV) testing, specialist consultation, intravenous steroid failure, colectomy, 30-day readmission, and mortality. Adherence was also compared between preguideline (2014–2018) and postguideline (2019–2024) time periods.Results Among 530 encounters reviewed, 35 patients met inclusion criteria, accounting for 56 admissions. VTE prophylaxis was administered in 43% of admissions, CMV testing in 30%, and C. difficile testing in 82%. Gastroenterology consultation occurred in 98% of admissions, whereas colorectal surgery consultation occurred in 30%. Intravenous steroid failure occurred in 18%, colectomy in 16%, and 30-day readmission in 23%. No in-hospital deaths occurred. Following guideline publication, VTE prophylaxis increased from 25% to 75% (P = 0.001) and CMV screening from 14% to 60% (P = 0.001).Conclusions Adherence to guideline-recommended ASUC management was variable, particularly for VTE prophylaxis and CMV testing, both of which improved significantly following the 2019 ACG guideline publication, underscoring the impact of guideline dissemination and highlighting remaining targets for quality improvement.