Pediatric Crohn’s Disease Activity Index (PCDAI)

Stratifies severity of Crohn’s disease in pediatric patients aged 19 and under.

Refer to the text below the calculator for more information on the original study and the index’s statistical properties.


PCDAI is a disease severity stratification tool that can be used in patients aged 19 and under with a confirmed diagnosis of Crohn’s disease, during initial and follow-up visits.

The main advantages of PCDAI compared to the HBI are that it includes growth parameters and objective markers of inflammation, and it offers a well-defined scoring range.

It performed better at discriminating levels of disease activity, compared against the adult Crohn’s Disease Activity Index (CDAI).


PCDAI maximum score is 100, where the higher the score, the greater the disease severity, whilst each decrease in score by 12.5 points indicates clinically significant response to therapy.

Score Interpretation*

PCDAI Disease severity
<10 Remission
10 - 27.5 Mild Crohn’s Disease
30 - 37.5 Moderate Crohn’s Disease
≥40 Severe Crohn’s Disease

*From Turner 2010


History (1 week recall)

Abdominal pain

Stools per day

General wellbeing

Examination

Weight

Based on previous measurement at least 4-6 months earlier

Height at diagnosis (or at follow-up)

Abdomen

Perirectal disease

Extra-intestinal manifestations

Fever ≥38.5ºC (101.3ºF) for 3 days over past week, arthritis, uveitis, erythema nodosum, or pyoderma gangrenosum

Laboratory

Gender
Age
Hematocrit
ESR
Albumin
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Index explained

PCDAI is a disease severity stratification tool that can be used in patients aged 19 and under with a confirmed diagnosis of Crohn’s disease, during initial and follow-up visits.

The index is based on three groups of findings, patient history information, examination findings and laboratory.

Pediatric Crohn’s Disease Activity Index
Patient History Points
Abdominal pain None 0
Mild: brief, does not interfere with activities 5
Moderate/Severe: daily, longer lasting affects activities, nocturnal 10
Stools per day   Formed stools or up to 1 liquid stool,  no blood 0
Up to 2 semi-formed with small blood, or 2-5 liquid with or without small blood 5
Any gross bleeding, or ≥ 6 liquid, or nocturnal diarrhoea 10
General wellbeing No limitation of activities, well 0
Occasional difficulty in maintaining appropriate activities, below par 5
Frequent limitation of activity, very poor 10
Examination
Weight (based on previous measurement at least 4-6 months earlier) Weight gain, weight stable or voluntary weight loss 0
Weight involuntarily stable or weight loss 1-9% 5
Weight loss ≥10% 10
Height at diagnosis (or at follow-up)   <1 channel decrease (or height velocity ≥ -1SD) 0
Channel decrease ≥1 and <2 (or height velocity <-1SD and >-2SD) 5
≥2 channel decrease (or height velocity ≤-2SD) 10
Abdomen   No tenderness, no mass 0
Tenderness, or mass without tenderness 5
Tenderness, involuntary guarding, or definite mass 10
Perirectal disease None, asymptomatic tags 0
1–2 indolent fistulae, scant drainage, and no tenderness 5
Active fistula, drainage, tenderness, or abscess 10
Extra-intestinal manifestations Fever ≥38.5ºC (101.3ºF) for 3 days over past week, arthritis, uveitis, erythema nodosum, or pyoderma gangrenosum None 0
One 5
Two or more 10
Laboratory
Hematocrit Interpretation depends on age and sex
<10 years Female, 11 – 19 years Male, 11–14 years Male, 11–14 years Male, 15–19 years  
>33 ≥34 ≥35 ≥35 ≥37 0
28 – 32 29 – 33 30 - 34 30 - 34 32 - 36 2.5
<28 <29 <30 <30 <32 5
ESR mm/hr <20 0
20  - 50 2.5
>50 5
Albumin g/dL (g/L) ≥ 3.5 0
3.1 – 3.4 5
≤ 3.0 10

Weight is calculated based on previous measurement, taken at least 4-6 months earlier.

Height is compared against the percentile prior to the onset of symptoms for the initial visit then height velocity should be calculated based on a value from the previous 6–12 months, for follow-up visits.

Perianal skin tags alone do not add to the perirectal disease item. There must be additional findings such as drainage, tenderness, or fistula.

PCDAI maximum score is 100, where the higher the score, the greater the disease severity, whilst each decrease in score by 12.5 points indicates clinically significant response to therapy.

PCDAI Disease severity
<10 Remission
10 - 27.5 Mild Crohn’s Disease
30 - 37.5 Moderate Crohn’s Disease
≥40 Severe Crohn’s Disease

Table Source: Turner 2010

PCDAI is regularly used in research as an objective measure for tracking treatment outcomes. The score has been found to be responsive to improvement over intervals as short as 4 weeks. Changes in PCDAI match with Physician Global Assessment over time.

PCDAI performed better at discriminating levels of disease activity, compared against the adult Crohn’s Disease Activity Index (CDAI).

 

About the original study

An index of severity of illness previously developed by a group of 30 pediatric gastroenterologists from 12 North American centers at a research forum was employed for clinical and laboratory observation of 133 children and adolescents with Crohn’s disease. During that development and validation study, the index was compared against physician global assessment, as well as the modified Harvey-Bradshaw Index (which includes only subjective and exam data) finding strong agreement with both.

Excellent interobserver agreement was noted for all three indexes. Increasing PCDAI scores were noted with increasing disease severity, and significant differences in scores were noted between the severity groups.

The main advantages of the PCDAI compared to the HBI are that it includes growth parameters and objective markers of inflammation, and it offers a well-defined scoring range.

 

Validation and other studies

Further from the original study, Hyams et al. published a validation study with data from 18 pediatric gastroenterology centers in the US and Canada, which included the index measures at diagnosis, 30 days, 3 months after diagnosis then quarterly after (for patients under 16). This aimed to evaluate the responsiveness of the PCDAI to changes in the status of patients after therapeutic interventions.

PCDAI scores were found to accurately reflect disease activity as assessed by physician global assessment.

A PCDAI score of 10 distinguished best (from specificity and sensitivity point of view) between inactive and mild disease. Large average decreases in PCDAI were observed in cases with moderate/severe disease by PGA at diagnosis, who improved to either inactive or mild disease.

Scores of 30 or more showed acceptable sensitivity and specificity to indicate disease of moderate/severe activity.

In 2010, Turner et al. evaluated the PCDAI on data from 437 children to retrieve cut-off values for disease degree severity. Their study concluded that the properties of the PCDAI adequately support its use in clinical research.

Otley et al. evaluated the feasibility, validity, and responsiveness of the PCDAI versus the CDAI in measuring disease activity in children with Crohn's Disease. Their findings indicated that the PCDAI was more effective than the CDAI at distinguishing between different levels of disease activity.

 

References

Original reference

Hyams JS, Ferry GD, Mandel FS, Gryboski JD, Kibort PM, Kirschner BS, Griffiths AM, Katz AJ, Grand RJ, Boyle JT, et al. Development and validation of a pediatric Crohn's disease activity index. J Pediatr Gastroenterol Nutr. 1991; 12(4):439-47.

Validation

Hyams J, Markowitz J, Otley A, Rosh J, Mack D, Bousvaros A, Kugathasan S, Pfefferkorn M, Tolia V, Evans J, Treem W, Wyllie R, Rothbaum R, del Rosario J, Katz A, Mezoff A, Oliva-Hemker M, Lerer T, Griffiths A; Pediatric Inflammatory Bowel Disease Collaborative Research Group. Evaluation of the pediatric crohn disease activity index: a prospective multicenter experience. J Pediatr Gastroenterol Nutr. 2005; 41(4):416-21.

Other references

Turner D, Griffiths AM, Walters TD, Seah T, Markowitz J, Pfefferkorn M, Keljo D, Otley A, Leleiko NS, Mack D, Hyams J, Levine A. Appraisal of the pediatric Crohn's disease activity index on four prospectively collected datasets: recommended cutoff values and clinimetric properties. Am J Gastroenterol. 2010; 105(9):2085-92.

Otley A, Loonen H, Parekh N, Corey M, Sherman PM, Griffiths AM. Assessing activity of pediatric Crohn's disease: which index to use? Gastroenterology. 1999; 116(3):527-31.

Kundhal PS, Critch JN, Zachos M, Otley AR, Stephens D, Griffiths AM. Pediatric Crohn Disease Activity Index: responsive to short-term change. J Pediatr Gastroenterol Nutr. 2003 Jan.


Specialty: Pediatrics

System: Digestive

Objective: Stratification

Type: Index

No. Of Items: 13

Year Of Study: 1991

Abbreviation: PCDAI

Article By: Denise Nedea

Published On: May 12, 2024

Last Checked: May 12, 2024

Next Review: May 12, 2029