Crohn's disease: the Crohn's disease activity index may identify patients in remission.

Clinical bottom line (level 2a)

  1. A Crohn's disease activity index may help identify patients who are well or unwell.
  2. The utility of this score has yet to be determined.
Best et al: Gastroenterology 1976; 70 (3): 438-444
Expires May 2003

The study

Setting: 13 acute hospitals, USA

112 patients (aged 35% aged 25-40 years, 54% male) with 187 attendances with Crohn's disease

Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • clinician's assessment of disease severity
Diagnostic test: clinical prediction rule- Crohn's disease activity index, based on symptoms over last week:
  • number of liquid or very soft stools: multiplication factor, 2
  • abdominal pain (0 = none; 1 = mild; 2 = moderate, 3 =severe): 5
  • general well-being (0 = generally well, 1 = slightly under par, 2 = poor, 3 = very poor, 4 = terrible): 7
  • number of complaints patient now has: arthritis/ athralgia; iritis/ uveitis; erythema nodosum/ pyoderma gangrenosum/apthous stomatitis; anal fissure, fistula or abscess; other fistula; fever > 37.8 C in last week: 20
  • taking loperamide/opiates for diarrhoea (0 = no, 1 = yes): 30
  • abdominal mass (0 = none, 2 = questionable, 5 = definite): 10
  • haematocrit: male (47- Hct); female (42- Hct): 6
  • % below predicted body weight: 1

  • Mulitple regression analysis was used to select the criteria that predicted clinical severity.

The evidence


diagnostic test very well, or fair to good poor or very poor LR
(95% CI)		 post-test probability
CDAI score 150 or or less 57 1 13
(1.8 to 85) 		98%
CDAI score 151 to 300 32 3 2.3
(0.80 to 6.9) 		91%
CDAI score 300 or more 2 16 0.0275
(0.0069 to 0.11) 		11%
total 91 20

  • No patient who was well had a CDAI score of 400 or more.

Comments

  1. This clinical prediction rule needs to be validated in an independent set of patients, and further assessed for its use in helping identify patients in remission or relapse.

Citation

  1. Best WR, Becktel JM, Singleton JW, et al: development of a Crohn's disease activity index: National Cooperative Crohn's Disease Study. Gastroenterology 1976; 70 (3): 438-444
Search Terms: reference from review article
Contributor: Chris Ball and Clare Wotton, May 2003
Reviewer:

Clinical Question.
Patient Crohn's disease
Intervention or Exposure Crohn's disease activity index
Outcome well, unwell