Pediatric Crohn disease activity index (PCDAI)

History (recall, 1 week)
Abdominal pain
None	____(0)
Mild – Brief, does not interfere with activities	____(5)
Moderate or severe – Daily, longer lasting, affects activities, nocturnal	____(10)
Stools (per day)
0 to 1 liquid stools, no blood	____(0)
Up to 2 semi-formed stools with small blood, or 2 to 5 liquid stools without blood	____(5)
Gross bleeding, or ≥6 liquid stools, or nocturnal diarrhea	____(10)
Patient functioning, general well-being (recall, 1 week)
No limitations of activities, well	____(0)
Occasional difficulty in maintaining age-appropriate activities, below par	____(5)
Frequent limitation of activity, very poor	____(10)
Laboratory
HCT (%)
<10 years
>33	____(0)
28 to 32	____(2.5)
<28	____(5)
11 to 19 years (females)
≥34	____(0)
29 to 33	____(2.5)
<29	____(5)
11 to 14 years (males)
≥35	____(0)
30 to 34	____(2.5)
<30	____(5)
15 to 19 years (males)
≥37	____(0)
32 to 36	____(2.5)
<32	____(5)
ESR (mm/hour)
<20	____(0)
20 to 50	____(2.5)
>50	____(5)
Albumin (g/dL)
≥3.5	____(0)
3.1 to 3.4	____(5)
≤3	____(10)
Examination
Weight
Weight gain, weight stable, or voluntary weight loss	____(0)
Involuntary weight stable, or weight loss 1 to 9%	____(5)
Weight loss ≥10%	____(0)
Height
At diagnosis
<1 channel decrease*	____(0)
1 to 2 channel decrease	____(5)
≥2 channel decrease	____(10)
or
Follow-up^¶
High velocity ≥-1 SD	____(0)
High velocity between -1 and -2 SD	____(5)
High velocity ≤-2 SD	____(10)
Abdomen
No tenderness, no mass	____(0)
Tenderness, or mass without tenderness	____(5)
Tenderness, involuntary guarding, definite mass	____(10)
Perirectal disease
None, asymptomatic tags	____(0)
1 to 2 indolent fistula(e), scant drainage, no tenderness	____(5)
Active fistula, drainage, tenderness, or abscess	____(10)
Extraintestinal manifestations
(Fever ≥38.5°C for 3 days over past week, definite arthritis, uveitis, erythema nodosum, pyoderma gangrenosum)
None	____(0)
1	____(5)
≥2	____(10)
Total score	________

The PCDAI is interpreted as follows: a score of 0 to 10 indicates inactive disease, 11 to 30 indicates mild disease activity, and >30 indicates moderate to severe disease activity. A decrease in PCDAI of ≥12.5 points reflects a clinical response (improvement from moderate/severe to mild/inactive disease)^[1].
A weighted version of the PCDAI (wPCDAI) has also been developed (not shown here), with a maximum score of 125^[2]. For the wPCDAI, a score of <12.5 indicates remission, 12.5 to 40 indicates mild disease activity, 40 to 57.5 indicates moderate disease activity, and >57.5 indicates severe disease activity.

PCDAI: pediatric Crohn disease activity index; HCT: hematocrit; ESR: erythrocyte sedimentation rate; SD: standard deviation.
* A "channel decrease" refers to serial height measurements that deviate across the width of a major curve on a standard height-for-age chart. For example, decreasing from the 40^th to 20^th percentile is a 1-channel decrease.
¶ Height velocity is measured against population standards, eg, Tanner JM, Davies S. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 1985; 107:317.

References:

Hyams J, Markowitz J, Otley A, et al. Evaluation of the pediatric Crohn disease activity index: a prospective multicenter experience. J Pediatr Gastroenterol Nutr 2005; 41:416.
Turner D, Griffiths AM, Walters TD, et al. Mathematical weighting of the pediatric Crohn's disease activity index (PCDAI) and comparison with its other short versions. Inflamm Bowel Dis 2012; 18:55.

Table from: Hyams JS, Ferry GD, Mandel FS, et al. Development and validation of a pediatric Crohn's disease activity index. J Pediatr Gastroenterol Nutr 1991; 12:439. Reproduced with permission from Lippincott Williams & Wilkins. Copyright © 1991 ESPGHAN and NASPGHAN. Unauthorized reproduction of this material is prohibited.

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Pediatric Crohn disease activity index (PCDAI)