title: Evaluation of the pediatric crohn disease activity index: a prospective multicenter experience.
abstract: OBJECTIVE
  Longitudinal assessment of disease activity is necessary for studies of therapeutic intervention in children with Crohn disease. The Pediatric Crohn Disease Activity Index (PCDAI) was developed a decade ago for such a purpose, but it function has only been examined in a small number of studies with a limited number of patients. The primary objectives of the present study were to develop cut scores reflecting disease activity as determined by physician global assessment (PGA) and to evaluate the responsiveness of the PCDAI to changes in patient condition after therapeutic interventions.
  
  
  METHODS
  Data were derived from a prospective database of newly diagnosed children with inflammatory bowel disease established in 2002 at 18 pediatric gastroenterology centers in the United States and Canada. At diagnosis, at 30 days and 3 months after diagnosis, and quarterly thereafter, children (<16 years of age) with Crohn disease had disease assessment performed by PGA and PCDAI. Disease management was provided according to the dictates of the attending gastroenterologist and not by predetermined protocol.
  
  
  RESULTS
  181 patients had concomitant PGA and PCDAI performed at diagnosis, and 95 of these had similar assessment at short-term follow up. Mean +/- SD PCDAI scores for mild, moderate, and severe disease by PGA at diagnosis were 19.5 +/- 10.4, 32.2 +/- 12.7, and 47.8 +/- 14.9, respectively (P < 0.001 for all comparisons). Mean +/- SD PCDAI for inactive disease after treatment was 5.2 +/- 5.4. Receiver operating characteristic (ROC) curve analysis suggested that: 1) activity of moderate/severe disease was best reflected by a PCDAI of > or = 30 points, 2) clinical response (moderate/severe disease improving to mild/inactive) was best reflected by a decrease in PCDAI of > or = 12.5 points, and 3) a PCDAI < 10 best reflected inactive disease.
  
  
  CONCLUSIONS
  PCDAI scores accurately reflect disease activity as assessed by physician global assessment. A PCDAI score of > or = 30 has acceptable sensitivity and specificity to indicate disease of moderate/severe activity. A PCDAI decrease of 12.5 points or greater following therapeutic intervention accurately reflects a clinically significant response. The PCDAI is an appropriate tool for intervention trials in Crohn disease in children.
authors.affiliation: Connecticut Children's Medical Center, Hartford, Connecticut, USA. 06106jhyams@ccmckids.org
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: M
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: Vasundhara
authors.initials: V
authors.lastname: Tolia
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: William
authors.initials: W
authors.lastname: Treem
authors.forename: Robert
authors.initials: R
authors.lastname: Wyllie
authors.forename: Robert
authors.initials: R
authors.lastname: Rothbaum
authors.forename: J
authors.initials: J
authors.lastname: del Rosario
authors.forename: Aubrey
authors.initials: A
authors.lastname: Katz
authors.forename: Adam
authors.initials: A
authors.lastname: Mezoff
authors.forename: M
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
mesh_terms: D002648:Child; D003424:Crohn Disease / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index