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    Patent Pending

    Pediatric Crohn’s Disease Activity Index (PCDAI)

    Stratifies severity of Crohn’s disease in pediatric patients.
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    INSTRUCTIONS

    Use in patients ≤19 years old.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients ≤19 years old with confirmed diagnosis of Crohn’s disease.
    • Can be used in initial or follow-up visits to assess and track severity.
    • The Pediatric Crohn’s Disease Activity Index (PCDAI) was developed to stratify severity of Crohn’s disease in pediatric patients.
    • Maximum possible score is 100, and each decrease in score by 12.5 points indicates clinically significant response to therapy.
    • Symptom scores are based on recall from the previous week.
    • Calculate weight based on previous measurement at least 4–6 months earlier.
    • Perianal skin tags alone do not add to the “Perirectal disease” component of the score. There must be additional findings such as drainage, tenderness, or fistula.
    • Height is scored differently for initial visits versus follow-up visits. At initial visit, height should be compared against percentile prior to the onset of symptoms. On follow-up, height velocity should be calculated based on a value from the previous 6–12 months.
    • Combines essential subjective information, examination findings, and labs into a single score.
    • Commonly used in research to help assess treatment outcomes.
    History: Based on recall from the previous week
    None
    0
    Mild: Does not interfere with activities
    +5
    Moderate/Severe: Daily, longer lasting, affects activities, nocturnal
    +10
    0–1 liquid stools, no blood
    0
    2-5 liquid or ≤2 semi-formed with small blood
    +5
    ≥6 liquid, gross blood, or nocturnal diarrhea
    +10
    Well (no limitation of activities)
    0
    Below par (occasional difficulty in maintaining age-appropriate activities)
    +5
    Very poor (frequent limitation of activity)
    +10
    Examination
    Weight gain, weight voluntarily stable, or voluntary weight loss
    0
    Weight involuntarily stable or weight loss 1–9%
    +5
    Weight loss ≥10%
    +10
    <1 channel decrease (or height velocity ≥ -1SD)
    0
    Channel decrease ≥1 and <2 (or height velocity <-1SD and >-2SD)
    +5
    ≥2 channel decrease (or height velocity ≤-2SD)
    +10
    No tenderness, no mass
    0
    Tenderness, or mass without tenderness
    +5
    Tenderness, involuntary guarding, or definite mass
    +10
    None or asymptomatic tags
    0
    1–2 indolent fistulae, scant drainage, and no tenderness
    +5
    Active fistula, drainage, tenderness, or abscess
    +10
    None
    0
    1
    +5
    ≥2
    +10
    Laboratory
    Male
    Female
    years
    %
    mm/hr
    g/dL

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Note that hematocrit parameters differ based on age and sex.

    Management

    • Increasing score should prompt consideration of further evaluation or change in therapy.
    • If score is abnormal in subjective components only, it is possible that functional abdominal pain, rather than Crohn’s disease, is responsible.
    Content Contributors
    • Peter Townsend, MD
    About the Creator
    Dr. Jeffrey Hyams
    Are you Dr. Jeffrey Hyams?
    Content Contributors
    • Peter Townsend, MD