Harvey Bradshaw Index For Crohn’s Disease
Stratifies Crohn’s disease severity based on characteristics of the disease.
In the text below the calculator there is information about the index and its result interpretation.
The Harvey Bradshaw Index is a stratification tool dedicated at staging Crohn’s disease based on patient reported symptoms and information about stool frequency.
This is a recommended and easy to use model as it accounts for readily available data.
Other tools, such as the CDAI, may require test results. The result provided can immediately be associated with one of the stages of disease activity.
The index has been created in 1980 by Harvey and Bradshaw. Scores range from 0 to more than 18, dependant on the patient answer in the stool item.
Depending on the result, the disease activity is interpreted as follows:
■ Scores less than 5 indicate remission;
■ Scores between 5 and 7 indicate mild activity;
■ Between 8 and 16 suggest moderate activity;
■ While scores above 16 are consistent with severe Crohn’s disease.
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Harvey Bradshaw Index explained
The index was created in 1980 by Harvey and Bradshaw as a simpler alternative to the Crohn’s disease activity index (CDAI).
It is facile to calculate because it uses data about the patient that is readily available. By comparison CDAI requires biochemical test results.
The following table introduces the items in the Harvey-Bradshaw index and the number of points each answer is awarded:
| Item | Answers (points) |
| General well-being the day before | Very well (0) Slightly below par (1) Poor (2) Very poor (3) Terrible (4) |
| Abdominal pain the day before | None (0) Mild (1) Moderate (2) Severe (3) |
| Number of liquid or soft stools per day | The number introduced is used as points |
| Abdominal mass | None (0) Dubious (1) Definite (2) Definite and tender (3) |
| Complications (check any that apply) | None (0) Arthralgia (1) Uveitis (1) Erythema nodosum (1) Aphthous ulcers (1) Pyoderma gangrenosum (1) Anal fissure (1) New fistula (1) Abscess (1) |
The general well being item allows the assessor to quantify the general health status on a scale from very well to terrible.
The abdominal pain item allows a quantification of the level of pain, if present. The complications list consists in the most common complications of Crohn’s disease.
The index results have shown good correlation with the disease status another reason why the HBI is often used in practice, more than the CDAI.
HBI score interpretation
Each of the five items in the index is awarded a number of points. Therefore, the minimum score obtainable is 0, which indicates the absence of disease or the fact that the disease is in remission.
The maximum attainable score depends on the number of stools the patient identifies per day, however, it is in the range of 18.
The following table introduces the scores and their disease severity correspondent:
| HBI score | Interpretation |
| Less than 5 | Remission |
| 5 - 7 | Mild severity |
| 8 - 16 | Moderate severity |
| More than 16 | Severe |
Scores of less that 5 indicate that the patient’s Crohn’s disease is in remission while scores higher than 16 indicate severe disease activity.
Crohn’s disease stages
One of the specificities of Crohn’s disease is the fact that it varies in activity and symptoms and their intensity can range widely from one patient to another.
Therefore, it is important to understand what each degree of disease activity means.
Remission is the stage at which no disease symptoms present or if any, there are at low intensity. For some patients, remission can last from days to year while for others, relapses occur frequently.
The mild to moderate stage is similar, however, the intensity of the symptoms, if any, is higher. Occasionally, fever or pain may occur.
During the moderate to severe stage, symptoms such as high fever, significant weight loss, nausea, vomiting and pain, do not respond to normal treatment.
Severe Crohn’s disease is characterized by presence of significant symptoms, even if the patient is under treatment with steroids.
Symptoms are persistent vomiting, high fever and intestinal blockage and in some cases complications such as abscesses may occur.
Original study
Harvey RF, Bradshaw JM. A simple index of Crohn's-disease activity. Lancet. 1980; 1(8167):514.
Other references
1. Crama-Bohbouth G, Pena AS, Biemond I, Verspaget HW, Blok D, Arndt JW, Weterman IT, Pauwels EK, Lamers CB. Are activity indices helpful in assessing active intestinal inflammation in Crohn’s disease? Gut. 1989; 30(9): 1236–1240.
2. Irvine EJ, Feagan B, Rochon J, Archambault A, Fedorak RN, Groll A, Kinnear D, Saibil F, McDonald JW. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn's Relapse Prevention Trial Study Group. Gastroenterology. 1994; 106(2):287-96.
Specialty: Gastroenterology
System: Digestive
Objective: Severity Stratification
Type: Index
No. Of Items: 5
Year Of Study: 1980
Abbreviation: HBI
Article By: Denise Nedea
Published On: April 6, 2017 · 06:42 AM
Last Checked: April 6, 2017
Next Review: April 6, 2023