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P263 Agreement between on-line patient reported and onsite physician assessed activity on the Simple Clinical Colitis Activity Index (SCCAI) domains. CRONICA-UC study

J. Panés*1, E. Domènech2, P. Nos3, I. Marín-Jiménez4, S. Riestra5, J.P. Gisbert6, D. Carpio7, X. Cortés8, E. Iglesias9, B. Juliá10, C. Romero10, A. Subtil10, O. Rincón10, L. Cea-Calvo10

1Hospital Clinic Universitario de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain, 2Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain, 3Hospital Universitari I Politècnic La Fe, Gastroenterology Unit, Valencia, Spain, 4Hospital General Universitario Gregorio Marañón, Gastroenterology Unit, Madrid, Spain, 5Hospital Central de Asturias, Gastroenterology unit, Oviedo, Spain, 6Hospital La Princesa , IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 7Complejo Hospitalario de Pontevedra, Gastroenterology Unit, Pontevedra, Spain, 8Hospital de Sagunto, Gastroenterology Unit, Sagunto, Spain, 9Hospital Universitario Reina Sofia, Unidad Clinica de Aparato Digestivo, Cordoba, Spain, 10MSD Spain, Medical Department, Madrid, Spain

Background

In the CRONICA-UC study, the performance of the SCCAI self-administered by the patient through an online tool was evaluated compared to the SCCAI assessed by the gastroenterologist in the clinic (considered as reference). We here report the agreement on the different domains of the SCCAI between patient and gastroenterologist assessments.

Methods

Patients aged ≥18 years-old with UC and at least one flare within the previous year were included and followed-up during 6 months. After a screening baseline visit, patients completed the SCCAI at home through a private website at months 3 and 6, and thereafter (<48 hours later) it was completed onsite by the gastroenterologist who was blinded to patient score. The agreement between patient and physician SCCAI scores was assessed for each SCCAI domain with the percentage of agreement, the Cohen's kappa and the Spearman's Rho coefficients.

Agreement in the different domains.

Percentage of agreement (95% CI)KappaSperman’s Rho
Bowel frequency during the day89.9% (86.1–92.8)0.6610.716
Bowel frequency during the night93.3% (90.1–95.7)0.6410.646
Urgency of defecation75.4% (70.5–79.9)0.570.675
Blood in stool81.3% (76.7–85.3)0.6030.814
General well being80.4% (75.8–84.5)0.6290.706
Arthritis88.5% (84.7–91.5)0.5840.602

Concurrence between the patient self-assessed and the physician scores in the “Urgency of defecation” domain

Patient SCCAI
NoneHurryImmediatelyIncontinenceTotal
None131 (38.3%)52 (15.2%)4 (1.2%)0 (0%)187 (54.7%)
Gastroenterologist SCCAIHurry9 (2.6%)117 (34.2%)9 (2.6%)1 (0.3%)136 (39.8%)
Immediately0 (0%)4 (1.2%)10 (2.9%)2 (0.6%)16 (4.7%)
Incontinence0 (0%)0 (0%)3 (0.9%)0 (0%)3 (0.9%)
Total140 (40.9%)173 (50.6%)26 (7.6%)3 (0.9%)342 (100%)

Results

We included 199 patients (mean age: 39.3 years [SD 11.4 (18.5-67.4)], 55.8% women). The highest agreement was seen for the domains "bowel frequency during the day" and "bowel frequency during the night" (table 1). The prevalence of extra-intestinal manifestations (EIMs), except arthritis, was very low, but agreement was high (88.5% for arthritis, and >90% for the remaining EIMs). The lowest agreement was seen for the "urgency of defecation" domain: patients scored the "urgency of defecation" higher than clinicians in 68 cases, whilst they scored lower in 16 cases (table 2).

Conclusion

In general, the agreement in the assessment of each domain of the SCCAI between patients and physicians was high. The lowest concurrence, seen in the "urgency of defecation" domain, was mainly due to underestimation by the physician, which could be due to suboptimal patient-physician communication or symptom misunderstanding.

Funded by Merck Sharp & Dohme, Spain [1] [2]

References:

[1] R S Walmsley,R C S Ayres, R E Pounder, R N Allan, (1998), A simple clinical colitis activity index, 43:29-32

[2] Bennebroeck F et al., (2013), The Patient Simple Clinical Colitis Activity Index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission: A comparison of the P-SCCAI with clinician-based SCCAI and biological markers, Journal of Crohn's and Colitis, 7, 890-900