Short pediatric Crohn's disease activity index for quality improvement and observational research.
BACKGROUND
Practical and objective instruments to assess pediatric Crohn's disease (CD) activity are required for observational research and quality improvement. The objectives were: 1) to determine the feasibility of completing the Pediatric Crohn's Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI); and 2) to create a Short PCDAI by retaining and reweighting the most practical and informative components.


METHODS
Physicians in the ImproveCareNow Collaborative for pediatric inflammatory bowel disease (IBD) were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each patient encounter. We assessed the feasibility of the PCDAI, the APCDAI, and the individual index components by determining the proportion of visits in which data were recorded. We created a short index by retaining and reweighting components of the PCDAI completed in ≥80% of visits. The feasibility of the Short PCDAI and its ability to discriminate between PGA categories were evaluated using descriptive statistics.


RESULTS
This study population included 1355 subjects with CD (6373 visits). The PCDAI and APCDAI were complete in 16.7% and 44.1% of visits, respectively. A Short PCDAI, including general well-being, abdominal pain, stools, weight, abdominal exam, and extraintestinal manifestations were completed in 66.5% of visits. The correlation between the Short PCDAI and PGA was similar to that of the PCDAI (r = 0.60, P < 0.001 versus 0.61, P < 0.001).


CONCLUSIONS
The Short PCDAI is a practical and valid tool to measure pediatric CD activity. Its use should facilitate quality improvement and observational research.
Kappelman
Michael D
MD
Department of Pediatrics, University of North Carolina at Chapel Hill, North Carolina, USA. michael_kappelman@med.unc.edu
Crandall
Wallace V
WV
Colletti
Richard B
RB
Goudie
Anthony
A
Leibowitz
Ian H
IH
Duffy
Lynn
L
Milov
David E
DE
Kim
Sandra C
SC
Schoen
Bess T
BT
Patel
Ashish S
AS
Grunow
John
J
Larry
Evette
E
Fairbrother
Gerry
G
Margolis
Peter
P
D000293:Adolescent; D015331:Cohort Studies; D003424:Crohn Disease / Q000628:therapy; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians; D011446:Prospective Studies; D036301:Qualitative Research; D058996:Quality Improvement; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
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