Harvey Bradshaw Index For Crohn’s Disease Calculator

How does this Harvey Bradshaw Index for Crohn’s disease calculator work?

This health tool evaluates disease severity for patients suffering from Crohn’s disease and provides an interpretable numeric score.

The HBI was created in 1980 as a simpler version of the Crohn’s disease activity index (CDAI) to facilitate its usage in day to day clinical settings. For facility of use, it collects only data readily available about the patient and doesn’t require any biochemical tests like the CDAI.

The Harvey Bradshaw Index for Crohn’s disease calculator takes account of the following five factors:

■ General well-being the day before – allows the subject to quantify their general health status in the day before the evaluation on a scale from 0 to 4, where 0 means very well and 4 means terrible.

■ Abdominal pain the day before – makes provision for quantification of an existant abdominal pain on an ordinal scale from 0 to 3, 3 being the severe pain.

■ Number of liquid or soft stools per day – quantifies the number of characteristic stools per day and uses it in the final score.

■ Abdominal mass – allows the allocation of a number of points from 0 to 3, depending on the degree of possibility of an abdominal mass being present.

■ Complications – provides a list of possible bowel disease complications from which the subject chooses the ones present in their case. Each of the selections is awarded 1 point in the final score:

- Arthralgia;

- Uveitis;

- Erythema nodosum;

- Aphthous ulcers;

- Pyoderma gangrenosum;

- Anal fissure;

- New fistula;

- Abscess.

Good correlation with the Crohn’s disease activity index has been proven and the HBI remains a popular tool because it is fast to complete and easy to interpret as there is no complex weighting system to use, such as in the case of CDAI.

HBI score interpretation

The Harvey Bradshaw Index quantifies the patient symptoms by correlating different numbers of points with the five criteria. The minimum score obtainable is 0, suggesting absence of disease or remission, while the maximum score obtainable goes beyond 18 points, depending on the number of stools the patient identifies per day.

Crohn’s disease stages

This type of disease affects people in different degrees and the reaction to the symptoms is different in the case of each patient. This is why the condition is often referred to in stages of severity:

■ Remission – no disease symptoms present or at low intensity. This period can last for days up to years in some cases while in others relapses occur frequently.

■ Mild to moderate – patients are able to eat food normally without any symptoms such as fever, dehydration, pain or intestinal blockage.

■ Moderate to severe – this stage does not respond to treatment or might present with high fever, significant weight loss, nausea, vomiting and pain.

■ Severe – presence of significant symptoms despite treatment with steroids, persistent vomiting, high fever, intestinal blockage and possible abscesses.

References

1) Harvey RF, Bradshaw JM. (1980) A simple index of Crohn’s-disease activity. Lancet; 315(8167):514.

2) Best WR. (2006) Predicting the Crohn’s disease activity index from the Harvey-Bradshaw Index. Inflamm Bowel Dis; 12(4):304-10.

3) Crama-Bohbouth G, Pena AS, Biemond I, Verspaget HW, Blok D, Arndt JW, Weterman IT, Pauwels EK, Lamers CB. (1989) Are activity indices helpful in assessing active intestinal inflammation in Crohn’s disease? Gut; 30(9): 1236–1240.

4) Falvey JD, Hoskin T, Meijer B, Ashcroft A, Walmsley R, Day AS, Gearry RB. (2015) Disease activity assessment in IBD: clinical indices and biomarkers fail to predict endoscopic remission. Inflamm Bowel Dis; 21(4):824-31.