title: Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS).
abstract: BACKGROUND
  Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC).
  
  
  OBJECTIVE
  To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated.
  
  
  METHODS
  A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors.
  
  
  RESULTS
  There was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity).
  
  
  CONCLUSIONS
  The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.
authors: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK. simon.travis@ndm.ox.ac.uk
authors: Simon P L
authors: SP
authors: Travis
authors: Dan
authors: D
authors: Schnell
authors: Piotr
authors: P
authors: Krzeski
authors: Maria T
authors: MT
authors: Abreu
authors: Douglas G
authors: DG
authors: Altman
authors: Jean-Frédéric
authors: JF
authors: Colombel
authors: Brian G
authors: BG
authors: Feagan
authors: Stephen B
authors: SB
authors: Hanauer
authors: Marc
authors: M
authors: Lémann
authors: Gary R
authors: GR
authors: Lichtenstein
authors: Phillippe R
authors: PR
authors: Marteau
authors: Walter
authors: W
authors: Reinisch
authors: Bruce E
authors: BE
authors: Sands
authors: Bruce R
authors: BR
authors: Yacyshyn
authors: Christian A
authors: CA
authors: Bernhardt
authors: Jean-Yves
authors: JY
authors: Mary
authors: William J
authors: WJ
authors: Sandborn
mesh_terms: D000208:Acute Disease; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology; D003106:Colon / Q000098:blood supply; D006801:Humans; D015588:Observer Variation; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D009626:Terminology as Topic; D014741:Video Recording