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Kappelman, M, Goudie, A. Crandall, W, Larry, E, Fairbrother, G, Margolis, P, Leibowitz, I, Duffy, L, Milov, D, Kim, S, Schoen, B, Cohen, S, Patel, A, Grunow, J, Colletti, R, and the ImproveCareNow Collaborative (formerly PIBDNet). A rapid pediatric Crohn's disease activity index for quality improvement and observational research. J Pediatr Gastroenterol Nutr 2009;48:e
Feasible and objective instruments to assess disease activity in pediatric Crohn's disease (CD) are needed for quality improvement (QI) and observational research. The feasibility of the full and abbreviated Pediatric Crohn's Disease Activity Indices (PCDAI and APCDAI) may be limited due to their requirement for laboratory testing and/or perirectal examination.
Objectives: 1) To determine the feasibility of completing the PCDAI and APCDAI in a pediatric inflammatory bowel disease (IBD) QI collaborative. 2) To create a rapid PCDAI by retaining and re-weighting the most feasible and informative components.
Methods: Physicians in the ImproveCareNow Collaborative for pediatric IBD were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each visit. We assessed the feasibility of the PCDAI, APCDAI, and each index component by determining the proportion of visits in which all required data were recorded. We created a rapid PCDAI by retaining components of the PCDAI completed in ≥80% of visits. We then used linear regression and clustered correlation to optimize component weighting. The performance of the rapid PCDAI was evaluated using standard descriptive statistics.
Results: In a population of 1123 subjects, the PCDAI could be scored in 709 of 3643 visits (19.5%) and the APCDAI could be scored in 1733 of 3643 visits (47.6%). A rapid PCDAI, including general well-being, abdominal pain, stools, weight, abdominal exam, and extra-intestinal manifestations had improved feasibility (could be scored in 2413 of 3643 visits, 66.2%) and strong correlation with the full index (r=0.86). The mean (+/- SD) rapid PCDAI scores (range 0-80) for patients with inactive, mild, moderate, and severe disease are 5.1 (7.5), 15 (10.9), 26 (14.5), and 37.6 (14.5) respectively.
Conclusion: The rapid PCDAI is a valid and feasible instrument, and should facilitate QI and observational research in pediatric CD.
[Poster Presentation at NASPGHAN Annual Meeting 2009]