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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:

    Please fill out required fields.

    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.

    Formula

    Addition of the selected points:

    History (based on recall within the previous week)

     

    0 points

    5 points

    10 points

    Abdominal pain

    None

    Mild (brief, does not interfere with activities)

    Moderate to severe (daily, longer lasting, affects activities, or nocturnal pain)

    Stools per day

    0–1 liquid stools, no blood

    Up to 2 semi-formed stool with small blood, or 2–5 liquid stools

    Gross bleeding or ≥6 liquid stools, or nocturnal diarrhea

    General well-being

    Well (no limitation of activities)

    Below par (occasional difficulty in maintaining age-appropriate activities)

    Very poor (frequent limitation of activity)

    Examination

     

    0 points

    5 points

    10 points

    Weight

    Weight gain, weight voluntarily stable, or voluntary weight loss

    Weight involuntarily stable or weight loss 1–9%

    Weight loss ≥10%

    Height*

         

    At diagnosis, or

    <1 channel decrease

    1 ≤ channel decrease < 2

    ≥2 channel decrease

    At follow-up

    Height velocity ≥-1SD

    -1SD > height velocity > -2SD

    Height velocity ≤-2SD

    Abdomen

    No tenderness, no mass

    Tenderness, or mass without tenderness

    Tenderness, involuntary guarding, or definite mass

    Peri-rectal disease

    None or asymptomatic tags

    1–2 indolent fistulae, scant drainage, and no tenderness

    Active fistula, drainage, tenderness, or abscess

    Extra-intestinal manifestations: Fever ≥38.5ºC (101.3ºF) for 3 days over past week, definite arthritis, uveitis, erythema nodosum, or pyoderma gangrenosum

    None

    1

    ≥2

    Laboratory

     

    0 points

    2.5 points

    5 points

    Hematocrit, %

         

    <10 years

    >33

    28–32

    <28

    Female, 11–19 years

    ≥34

    29–33

    <29

    Male, 11–14 years

    ≥35

    30–34

    <30

    Male, 15–19 years

    ≥37

    32–36

    <32

    ESR, mm/hr

    <20

    20–50

    >50

     

    0 points

    5 points

    10 points

    Albumin, g/dL (g/L)

    ≥3.5 (35)

    3.1–3.4 (31–34)

    ≤3.0 (30)

     Height velocity can be referenced here.

    Facts & Figures

    Interpretation:

    PCDAI

    Severity

    <10

    Remission

    10–27.5

    Mild Crohn’s Disease

    30–37.5

    Moderate Crohn’s Disease

    ≥40

    Severe Crohn’s Disease

    From Turner 2010, American Journal of Gastroenterology.

    Evidence Appraisal

    The PCDAI was developed by a group of 30 pediatric gastroenterologists with extensive experience in inflammatory bowel disease (IBD) management.

    The paper by Hyams et al initially describing the score compared scores for 133 patients against both physician global assessment, as well as the modified Harvey-Bradshaw Index (which includes only subjective and exam data) finding strong agreement with both. Interobserver agreement was strong as well.

    A follow up study by Otley et al found that PCDAI performed better at discriminating levels of disease activity, compared against the adult-oriented Crohn’s Disease Activity Index (CDAI).

    A decrease in score by 12.5 points was found to be optimal for detecting a clinically significant response to therapy (Turner et alKundhal et al).  The PCDAI has been found to be responsive to improvement over intervals as short as 4 weeks.

    A subsequent prospective validation study (Hyams et al 2005) confirmed that changes in PCDAI match with Physician Global Assessment over time.  This study helped to clarify which scores corresponded to levels of disease severity (see Facts & Figures).

    Dr. Jeffrey Hyams

    About the Creator

    Jeffrey Hyams, MD, is a professor of pediatrics at the University of Connecticut School of Medicine. He currently serves on the Rome Committee, an international research organization that investigates the course and treatment of functional GI disorders. Dr. Hyams' research focuses on pediatric digestive diseases, and he is a co-author of Pediatric Gastrointestinal and Liver Disease, now in its 5th edition.

    To view Dr. Jeffrey Hyams's publications, visit PubMed

    Content Contributors
    • Peter Townsend, MD
    About the Creator
    Dr. Jeffrey Hyams
    Content Contributors
    • Peter Townsend, MD