Pikarsky et al developed a scoring system for perianal Crohn's disease. This can be used to monitor a patient's disease activity and response to interventions. The authors are from the Cleveland Clinic in Weston, Florida.
Parameters:
(1) abscess
(2) fistula (4 measures)
(3) ulcer and fissure (2 measures)
(4) stenosis (2 measures)
(5) incontinence score (using the fecal incontinence grading score, above)
(6) concomitant disease in rectum (2 measures)
(7) concomitant disease in colon (2 measures)
(8) concomitant disease in small bowel (2 measures)
|
Parameter |
Finding |
Points |
|---|---|---|
|
abscess |
none |
0 |
|
|
first occurrence, single abscess |
1 |
|
|
first occurrence, multiple abscesses |
3 |
|
|
first recurrence, single or multiple abscesses |
4 |
|
|
multiple recurrences, single or multiple abscesses |
5 |
|
fistula, duration |
none |
0 |
|
|
short term (<= 30 days) |
1 |
|
|
long term (> 30 days) |
2 |
|
fistula, type |
first occurrence |
0 |
|
|
persistent post-surgical |
3 |
|
|
recurrent |
3 |
|
fistula, number |
single |
0 |
|
|
multiple |
3 |
|
fistula, rectovaginal or rectourethral |
none |
0 |
|
|
first occurrence |
4 |
|
|
recurrent |
6 |
|
ulcer or fissure, duration |
none |
0 |
|
|
short term (<= 30 days) |
1 |
|
|
long term (> 30 days) |
2 |
|
ulcer or fissure, number |
none |
0 |
|
|
single |
1 |
|
|
multiple |
2 |
|
stenosis, duration |
none |
0 |
|
|
short term (<= 30 days) |
1 |
|
|
long term (> 30 days) |
2 |
|
stenosis, occurrence |
first occurrence |
0 |
|
|
recurrence |
4 |
|
incontinence |
none |
0 |
|
|
incontinence score 1 - 6 |
1 |
|
|
incontinence score 7 – 14 |
3 |
|
|
incontinence score > 14 |
5 |
|
rectal disease |
none |
0 |
|
|
moderate |
3 |
|
|
severe |
4 |
|
rectal disease, active fistula |
absent |
0 |
|
|
present |
4 |
|
colonic disease |
none |
0 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
colonic disease, active fistula |
absent |
0 |
|
|
present |
3 |
|
small bowel disease |
none |
0 |
|
|
moderate |
1 |
|
|
severe |
2 |
|
small bowel disease, active fistula |
absent |
0 |
|
|
present |
2 |
from Table 1, page 776
where:
• The table states that the maximum score for abscess is 8, but I cannot make it anything more than 5. I suppose that there is a typo and multiple recurrences should be scored 8 rather than 5. This affects the total score (below).
• The duration of fistula, ulcer/fissure and of stenosis was either < 30 or > 30 days. To cover 30 days I made it <= 30 days in the table above.
• There was no coverage for mild rectal, colonic or small bowel disease. I assigned the same number of points as moderate disease (making the category mild-moderate). Another option might be to assign these half the points assigned to moderate disease.
total PCDAI score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 55 according to the paper, 52 by my count (based on maximum abscess score of 5 rather than 8)
• The higher the score, the more severe the Crohn's disease.
|
Total Score |
Surgical Outcome |
|---|---|
|
<= 10 |
good |
|
11 – 19 |
fair (moderate) to poor |
|
>= 20 |
poor (failure) |
Specialty: Gastroenterology
