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Mathematical weighting of the pediatric Crohn's disease activity index (PCDAI) and comparison with its other short versions

Turner, Dan MD, PhD1,*; Griffiths, Anne M. MD2; Walters, Thomas D. MD2; Seah, Tong2; Markowitz, James MD3; Pfefferkorn, Marian MD4; Keljo, David MD5; Waxman, Jacob1; Otley, Anthony MD, MSc6; LeLeiko, Neal S. MD, PhD7; Mack, David MD8; Hyams, Jeffrey MD9; Levine, Arie MD10

doi: 10.1002/ibd.21649
Original Article

Background:: The Pediatric Crohn's Disease Activity Index (PCDAI) has become the standard outcome measure in pediatric Crohn's disease (CD) clinical research. Other versions have been proposed but without systematic evaluation. The aim was to assess validity and responsiveness of the abbreviated PCDAI (abbrPCDAI), short PCDAI (shPCDAI), and modified PCDAI (modPCDAI) as measures of disease activity and to compare these with a mathematically weighted version developed here (wPCDAI).

Methods:: The raw data from four prospectively collected datasets were used, totaling 437 children with CD (including two clinical trials). Discriminant validity utilized physician global assessment of disease activity (PGA), and construct validity the correlation with PGA and laboratory results. Feasibility and face validity were ascertained by a survey of 33 experts in pediatric CD.

Results:: The wPCDAI had better performance than the PCDAI in construct validity and responsiveness and it discriminated better between the disease activity categories (area under the receiver operator characteristic [ROC] 0.97; 95% confidence interval [CI]: 0.95–0.99). In comparison to the original PCDAI, the noninvasive versions (abbrPCDAI and shPCDAI) had lower face, construct, and discriminant validity but were judged to be significantly more feasible. The modPCDAI performed well in the construct validation but was consistently inferior in all other parameters. Cutoffs that correspond to remission, response, and gradations of disease activity were determined for each index.

Conclusions:: The newly weighted wPCDAI performed better than the original PCDAI and is more feasible. The noninvasive versions (shPCDAI and abbrPCDAI) are inferior to the full PCDAI, but when needed in retrospective studies either may be equally used. (Inflamm Bowel Dis 2011)

1 Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel

2 Hospital for Sick Children, Toronto, Ontario, Canada

3 North Shore‐Long Island Jewish Health System, New Hyde Park, New York

4 Riley Hospital for Children, Indianapolis, Indiana

5 Children's Hospital of Pittsburgh, Pennsylvania

6 IWK Health Centre, Halifax, Nova Scotia, Canada

7 Hasbro Children's Hospital, Providence, Rhode Island

8 Children's Hospital of Eastern Ontario, Ottawa, Canada

9 Connecticut Children's Medical Center, Hartford, Connecticut

10 Pediatric Gastroenterology Unit, Wolfson Medical Center, Tel Aviv University, Israel

* Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, The Hebrew University, P.O.B 3235, Jerusalem 91031, Israel

Email: turnerd@szmc.org.il

Received 28 November 2010; Accepted 27 December 2010

Published online 23 February 2011 in Wiley Online Library (wileyonlinelibrary.com).

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