Crohn's disease: the Harvey-Bradshaw index correlated closely with the Crohn's disease activity index and was simpler to use.

Clinical bottom line (level 4)

  1. Patients with Crohn's disease who scored 3 or more on the Harvey-Bradshaw index were very likely to be in remission according to the Crohn's disease activity index.
  2. Patients who scored 7 or more on the Harvey-Bradshaw index were very likely to be in relapse according to the Crohn's disease activity index.
  3. The index is purely clinical, and easier to use.
Harvey and Bradshaw: Lancet 1980; 1: 514-514
Expires May 2003

The study

Setting: university hospital, UK

112 patients (aged ?, ?% male) Crohn's disease, attending outpatient clinic

?independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • Crohn's disease activity index: in remission if < 150; extremely severe disease if > 450
Diagnostic test: diagnostic test: index based on patient's symptoms in previous 24 hours:
  • general well-being (0 = very well, 1 = slightly below par, 2 = poor, 3 = very poor, 4 = terrible)
  • abdominal pain (0 = none, 1 = mild, 2 = moderate, 3 = severe)
  • number of liquid stools per day
  • abdominal mass (0 = none, 1 = dubious, 2 = definite, 3 = definite and tender)
  • complications: arthralgia, uveitis, erythema nodosum, aphthous ulcers, pyoderma gangrenosum, anal fissure, new fistula, abscess (score 1 per item)

The evidence

pre-test probability of relapse: 32%, (95% CI: 24% to 41%)

diagnostic test complex index 150 or more complex index <150 LR
(95% CI)		 post-test probability
simple index 7 or more 16 1 34
(4.7 to 245) 		94%
simple index 4-6 16 10 3.4
(1.7 to 6.7) 		62%
simple index 3 or less 2 63 0.07
(0.02 to 0.26) 		3%
total 36 76

  • Correlation between two indices: r = 0.93 , p < 0.001
  • Only one patients had a CDAI score > 450, who scored 12 on the Harvey-Bradshaw index.

Comments

  1. This index is far simpler to use than the CDAI and does not require biochemical tests.

Citation

  1. Harvey RF, and Bradshaw JM: a simple index of Crohn's-disease activity. Lancet 1980; 1: 514-514
Search Terms: reference from review article
Contributor: Chris Ball and Clare Wotton, May 2000
Reviewer:

Clinical Question.
Patient Crohn's disease
Intervention or Exposure Harvey-Bradshaw index
Outcome relapse, remission