Assessing activity of pediatric Crohn's disease: Which index to use?

Background & Aims: The Pediatric Crohn's Disease Activity Index (PCDAI) is a multi-item measure that, in contrast to the adult-derived CDAI, includes linear growth and places less emphasis on subjectively reported symptoms bu t move on laboratory parameters of intestinal inflammation. This study comp ared the feasibility, validity, and responsiveness of PCDPI vs. CDAI in the assessment of Crohn's disease activity among pediatric patients. Methods: Eighty-one children and adolescents with Crohn's disease were studied. A ga stroenterologist provided a categorical global assessment of disease activi ty as quiescent, mild, moderate, or severe after interview and physical exa mination. CDAI and PCDAI scores were calculated by an independent appraiser . Results: Mean values within each category for CDAI and PCDAI differed sig nificantly between strata. PCDAI values were quiescent, 6.8 +/- 6.6; mild, 18.7 +/- 7.3; moderate, 38.5 +/- 12.9; and severe, 54.2 +/- 14.0. CDAI valu es were quiescent, 23.5 +/- 53.6; mild, 96.0 +/- 60.7; moderate, 184.5 +/- 97.0; and severe, 284.4 +/- 85.8. Individual scores showed less overlap bet ween strata for PCDAI than for CDAI. PCDAI showed better correlation with s erum orosomucoid and platelet count, laboratory parameters of inflammation not included in either index. Conclusions: Both PCDAI and CDAI reflect dise ase activity in pediatric Crohn's disease. PCDAI is better at discriminatin g between levels of disease activity.