An index for clinical activity in patients with Crohn's Disease was proposed by de Dombal et al in 1974. The index was based on the activity index of Truelove and Witts for ulcerative colitis. It uses 7 clinical features, with 3 gastrointestinal and 4 systemic.
Local features:
(1) number of bowel movements per day
(2) pain
(3) rectal bleeding
Systemic features:
(4) pulse
(5) temperature
(6) hemoglobin
(7) weight loss
|
Local Features |
Mild |
Moderate |
Severe |
|
bowel movements per day |
2 - 3 |
4 - 6 |
> 6 |
|
pain |
occasional and mild |
frequent and moderate |
continuous and severe |
|
rectal bleeding |
negligible |
small |
macroscopic |
|
Systemic Features |
Mild |
Moderate |
Severe |
|
pulse in beats per minute |
< 90 |
90 - 100 |
> 100 |
|
temperature in °C |
< 37.2 (99°F) |
37.2 |
> 37.2 (100°·F) |
|
hemoglobin in g/L |
> 80 |
70 - 80 |
< 70 |
|
weight loss in kilograms |
< 3.2 |
3.2 - 6.35 |
> 6.35 |
where:
• weight loss in the original article is in stone (14 pounds, or 6.34 kilograms)
Looking at the data, there is need also for a minimal activity or inactive group, with:
(1) 0-1 bowel movements per day
(2) no pain
(3) no rectal bleeding
(4) pulse 60-75
(5) temperature: ? 37°C
(6) hemoglobin > 125 g/L
(7) no weight loss
Limitations:
• Since it was based on an index for ulcerative colitis, it tends to show a bias towards colonic symptoms.
• Individual assessment of change in disease activity over the short term may be difficult., since a large number of patients are classified as showing moderate activity.
Specialty: Gastroenterology
