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 | ________ |
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