Scoring Indices for Perianal Fistulising Crohn's Disease: A Systematic Review

Authors:

Vuyyuru, S. K., Solitano, V., Singh, S., Hanzel, J., Macdonald, J. K., Danese, S., Peyrin Biroulet, L., Ma, C., and Jairath, V.

Abstract:

BACKGROUND AND AIMS: In this systematic review we summarise existing scoring indices for assessing disease activity and quality of life in perianal fistulising Crohn's disease [PFCD], and highlight gaps in the literature.

METHODS: MEDLINE, EMBASE, and CENTRAL were searched from August 24, 2022, to identify studies evaluating clinical, radiological, or patient-reported outcome measures [PROMS] in PFCD. The primary objective was to identify all available scoring indices and describe the operating properties of these indices.

RESULTS: A total of 53 studies reported on the use of one clinical index [Perianal Disease Activity Index: PDAI], three PROMs, and 10 radiological indices; 25 studies evaluated the operating properties of these indices. The PDAI demonstrated content validity, construct validity, and responsiveness but criterion validity or reliability were not assessed. The Van Assche Index [VAI], modified VAI, and the Magnetic Resonance Index for Assessing Fistulas in Patients with CD [MAGNIFI-CD] were the most studied radiological indices. These indices demonstrated responsiveness and reliability. The VAI and MAGNIFI-CD demonstrated construct validity; criterion and content validity and feasibility have not been assessed. Among the three PROMs, the Crohn's Anal Fistula Quality of Life index demonstrated content and construct validity, inter-observer reliability, and responsiveness; criterion validity, intra-observer reliability, and feasibility have not been assessed for this index.

CONCLUSIONS: There are no fully valid, reliable, and responsive clinical disease or radiological indices for PFCD. Although the radiological indices demonstrated responsiveness and reliability, well-defined cut-offs for response and remission are lacking. Future research should focus on establishing standardised definitions and thresholds for outcomes.

DOI:

10.1093/ecco-jcc/jjad214

Journal:

J Crohns Colitis

issn:

1873-9946

Publication year:

2024

pages:

836–850

Symptom status:

Emotional state
Physical state

Functional status:

Physical functioning
Role functioning
Social functioning

General health perceptions / HRQoL:

Health-related quality of life
Self-rated health

Age:

Adults (18-65)
Seniors (65+)

Disease:

Diseases of and symptoms related to the digestive system

PRO / non-PRO:

Non-patient Reported Outcome
Patient Reported Outcome

Type of measurement instrument:

1 - Questionnaires
6 - Clinical rating scales
8 - Imaging tests