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P127. Towards a patient reported Crohn's Disease Activity Index

E. McDermott1, S. O'Reilly1, V. Kale1, K. Byrne1, D. Keegan1, G. Doherty1, G. Cullen1, H. Mulcahy1, 1St Vincent's University Hospital, Centre for Colorectal Disease, Dublin, Ireland

Background

The Harvey Bradshaw Index (HBI) is frequently used in clinical practice to assess disease activity in Crohn's disease and requires a physician to record a number of intestinal and extraintestinal symptoms. However, with the advent of online follow-up, there is a requirement for a valid patient reported activity index.

Aim: To assess correlation between physician and patient reported HBI.

Methods

115 Crohn's disease patients (median age 35years, 60 male) attending an inflammaotry bowel disease (IBD) clinic completed a survey instrument containing the HBI, with minor modifications to increase understanding. The examining physician completed the Harvey Bradshaw Index (HBI) without reference to the patient. Demographics and physician reported HBI were recorded by an independent research clinician and subsequently compared to patient reported results.

Results

There was good correlation between physicians and patients regarding demographic details. The overall correlation coefficient between physician and patient reported HBI was modest at 0.46 (p < 0.0001), with physicians consistently reporting a lower index than patients. With regard to individual HBI components, the correlation coefficients included wellbeing, 0.37. (p < 0.001.), abdominal pain, 0.42 (p < 0.001.), liquid bowel motions 0.41 (p < 0.001.), abdominal mass 0.08 (p = 0.37), eyes −0.04 (p = 0.66), joints 0.23 (p = 0.01), skin 0.15 (p = 0.12), fever 0.07 (p = 0.43) and fistula 0.86 (p = 0.356). When questions relating to abdominal mass and extraintestinal features were discarded, i.e. a short HBI, there was a close association between physician reported disease activity and patient reported short HBI (median patient reported HBI 2 (IQR 0–3) for inactive disease vs. HBI 4 (IQR 3–7) for active disease (p < 0.0001).

Conclusion

Patients accurately report most demographics, however there is a relatively poor association between patient and physician reported HBI, particularly in relation to extraintestinal features. When such features were excluded, agreement on activity improved. Self-reporting of online data could be a valuable tool in research and clinical practice in IBD. For this purpose a short patient reported HBI may be useful for patients reporting of symptoms.