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Short pediatric Crohn's disease activity index for quality improvement and observational research

Kappelman, Michael D. MD, MPH1; Crandall, Wallace V. MD2; Colletti, Richard B. MD3; Goudie, Anthony PhD4; Leibowitz, Ian H. MD5; Duffy, Lynn MD5; Milov, David E. MD6; Kim, Sandra C. MD1; Schoen, Bess T. MD7; Patel, Ashish S. MD8; Grunow, John MD9; Larry, Evette MPH4; Fairbrother, Gerry PhD4; Margolis, Peter MD, PhD4

doi: 10.1002/ibd.21452
Original Clinical Articles

Background:: Practical and objective instruments to assess pediatric Crohn's disease (CD) activity are required for observational research and quality improvement. The objectives were: 1) to determine the feasibility of completing the Pediatric Crohn's Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI); and 2) to create a Short PCDAI by retaining and reweighting the most practical and informative components.

Methods:: Physicians in the ImproveCareNow Collaborative for pediatric inflammatory bowel disease (IBD) were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each patient encounter. We assessed the feasibility of the PCDAI, the APCDAI, and the individual index components by determining the proportion of visits in which data were recorded. We created a short index by retaining and reweighting components of the PCDAI completed in ≥80% of visits. The feasibility of the Short PCDAI and its ability to discriminate between PGA categories were evaluated using descriptive statistics.

Results:: This study population included 1355 subjects with CD (6373 visits). The PCDAI and APCDAI were complete in 16.7% and 44.1% of visits, respectively. A Short PCDAI, including general well‐being, abdominal pain, stools, weight, abdominal exam, and extraintestinal manifestations were completed in 66.5% of visits. The correlation between the Short PCDAI and PGA was similar to that of the PCDAI (r = 0.60, P < 0.001 versus 0.61, P < 0.001).

Conclusions:: The Short PCDAI is a practical and valid tool to measure pediatric CD activity. Its use should facilitate quality improvement and observational research. (Inflamm Bowel Dis 2011;)

1Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

2Division of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio

3Department of Pediatrics, University of Vermont, Burlington, Vermont

4Child Policy Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

5Inova Pediatric Digestive Disease Center, Fairfax, Virginia

6Nemours Children's Clinic, Orlando, Florida

7Department of Pediatrics, Emory University, Atlanta, Georgia

8Division of Gastroenterology, Children's Medical Center of Dallas, Dallas, Texas

9Department of Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma

Reprints: University of North Carolina Chapel Hill, Department of Pediatrics, Division of Pediatric Gastroenterology, 130 Mason Farm Road, campus box 7229, Chapel Hill, NC 27599

Email: michael_kappelman@med.unc.edu

Received 13 June 2010; Accepted 13 June 2010

Dr. Kappelman was supported in part by the National Center for Research Resources (NCRR) Grant KL2 RR025746 and the National Institute for Diabetes and Digestive and Kidney Diseases Grant P30 DK034987. Support for this analysis was also provided by the Agency for Healthcare Research and Quality grant HS 016957.

© Crohn's & Colitis Foundation of America, Inc.
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