Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study
Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study
Background In the absence of research into therapies and care pathways for long COVID, guidance based on ‘emerging experience’ is needed.
Aim To provide a rapid expert guide for GPs and long COVID clinical services.
Design and setting A Delphi study was conducted with a panel of primary and secondary care doctors.
Method Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of ‘strongly agree’, ‘agree’, or ‘neither agree nor disagree’ from 90% or more of responders were taken as showing consensus.
Results Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support.
Conclusion Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
Alwan, Nisreen
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Nurek, Martine
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Rayner, Clare
95e5c118-ca69-41cb-bf74-c6b63114b887
Freyer, Anette
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Taylor, Sharon
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Järte, Linn
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MacDermott, Nathalie
b5e96391-c335-48b9-869e-b98f858b5739
Delaney, Brendan C.
2776a608-8a24-46f3-8603-b9b4e831f02e
November 2021
Alwan, Nisreen
0d37b320-f325-4ed3-ba51-0fe2866d5382
Nurek, Martine
d0673b42-c82c-4a78-b688-5aeb834845ae
Rayner, Clare
95e5c118-ca69-41cb-bf74-c6b63114b887
Freyer, Anette
b8577fc5-c881-4ea7-abd5-504842fc42e8
Taylor, Sharon
05f23930-93ba-4eed-8186-df022c70e003
Järte, Linn
d52e6b37-bbc3-4390-bc4d-6d17d7131c0e
MacDermott, Nathalie
b5e96391-c335-48b9-869e-b98f858b5739
Delaney, Brendan C.
2776a608-8a24-46f3-8603-b9b4e831f02e
Nurek, Martine, Rayner, Clare, Freyer, Anette, Taylor, Sharon, Järte, Linn, MacDermott, Nathalie and Delaney, Brendan C.
,
Delphi Study Panel
(2021)
Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study.
British Journal of General Practice.
(doi:10.3399/BJGP.2021.0265).
Abstract
Background In the absence of research into therapies and care pathways for long COVID, guidance based on ‘emerging experience’ is needed.
Aim To provide a rapid expert guide for GPs and long COVID clinical services.
Design and setting A Delphi study was conducted with a panel of primary and secondary care doctors.
Method Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of ‘strongly agree’, ‘agree’, or ‘neither agree nor disagree’ from 90% or more of responders were taken as showing consensus.
Results Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support.
Conclusion Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
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Accepted/In Press date: 7 June 2021
e-pub ahead of print date: 28 October 2021
Published date: November 2021
Identifiers
Local EPrints ID: 480362
URI: http://eprints.soton.ac.uk/id/eprint/480362
ISSN: 0960-1643
PURE UUID: 95ecbb70-ed15-46b6-a991-09c9f54350eb
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Date deposited: 01 Aug 2023 17:51
Last modified: 17 Mar 2024 03:38
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Contributors
Author:
Martine Nurek
Author:
Clare Rayner
Author:
Anette Freyer
Author:
Sharon Taylor
Author:
Linn Järte
Author:
Nathalie MacDermott
Author:
Brendan C. Delaney
Corporate Author: Delphi Study Panel
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