Download PCDAI Clarified

PCDAI: *see
instructions on reverse re: scoring items marked *
EXAMINATION
HISTORY (Recall; 1 week)*
Abdominal pain:* None
Mild – Brief, does not interfere with activities
Mod / severe - daily, longer lasting, affects activities, nocturnal
_______(0)
_______ (5)
_______ (10)
Stools*: (per day)
Formed stools or up to 1 liquid stool, no blood
Up to 2 semi-formed with small blood, or 2-5 liquid
with or without small blood
Any gross bleeding, or > 6 liquid, or nocturnal diarrhea
_______ (0)
_______ (5)
_______ (10)
Weight*
Weight gain or voluntary weight stable/loss
Involuntary weight stable, weight loss 1-9%
Weight loss > 10%
Height* Score using (a) criteria when possible
a)
Height velocity > -1SD
Height velocity < - 1SD, >-2SD
Height velocity < - 2SD
b)
< 1 channel decrease
>1, < 2 channel decrease
> 2 channel decrease
Patient Functioning* – General Well-Being
No limitation of activities, well
Occasional difficulty in maintaining appropriate activities, below par
Frequent limitation of activity, very poor
LABORATORY
HCT (%)
(values obtained within the past week)
< 10 yrs :
>33
28-32
< 28
____ (0)
____ (2.5)
____ (5)
>35
30-34
< 30
____ (0)
____ (2-5)
____ (5)
Males 15-19yrs:
>37
32-36
< 32
____ (0)
____ (2.5)
____ (5)
Females 11-19yrs
> 34
29-33
< 29
____ (0)
____ (2.5)
____ (5)
ESR (mm/hr)
< 20
20-50
> 50
____ (0)
____ (2.5)
____ (5)
ALBUMIN (g/dL)
> 3.5
____ (0)
3.1-3.4 ____ (5)
< 3.0
____ (10)
Males 11-14yrs
_____ (0)
_____ (5)
_____ (10)
_____ (0)
_____ (5)
_____ (10)
OR
______ (0)
_______ (5)
_______ (10)
_____ (0)
_____ (5)
_____ (10)
Abdomen
No tenderness, no mass
Tenderness, or mass without tenderness
Tenderness, involuntary guarding, definite mass
_____ (0)
_____ (5)
_____ (10)
Perirectal disease
None, asymptomatic tags
_____ (0)
Inflamed tags or 1-2 indolent fistula(e) or fissure(s),
scant drainage, no tenderness
_____ (5)
Active fistula, drainage, tenderness, or abscess
_____ (10)
Extra-intestinal Manifestations
(Fever > 38.5 for 3 days over past week, oral ulcers
definite arthritis, uveitis, E.nodosum,
P. gangrenosum)
None
One
> Two
TOTAL SCORE
_____ (0)
_____ (5)
_____ (10)
_________________________________