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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Comparing disease activity indices in ulcerative colitis
Journal of Crohn's and Colitis, Volume 8, No. 4, Year 2014
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Description
Background: Comparisons between disease activity indices for ulcerative colitis (UC) are few. This study evaluates three indices, to determine the potential impact of inter-observer variation on clinical trial recruitment or outcome as well as their clinical relevance. Methods: One hundred patients with UC were prospectively evaluated, each by four specialists, followed by videosigmoidoscopy, which was later scored by each specialist. The Simple Clinical Colitis Activity (SCCAI), Mayo Clinic and Seo indices were compared by assigning a disease activity category from published thresholds for remission, mild, moderate and severe activity. Inter-observer variation was evaluated using Kappa statistics and its effect for each patient on recruitment and outcome measures for representative clinical trials calculated. Clinical relevance was assessed by comparing an independently assigned clinical category, taking all information into account as if in clinic, with the disease activity assigned by the indices. Results: Inter-observer agreement for SCCAI (κ. = 0.75, 95% CI 0.70-0.81), Mayo Clinic (κ. = 0.72, 95% CI 0.67-0.78) and Seo (κ. = 0.89, 95% CI 0.83-0.95) indices was good or very good as was the agreement for rectal bleeding (κ. = 0.77) and stool frequency (κ. = 0.90). Endoscopy in the Mayo Clinic index had the greatest variation (κ. = 0.38). Inter-observer variation alone would have excluded up to 1 in 5 patients from recruitment or remission criteria in representative trials. Categorisation by the SCCAI, Mayo Clinic and Seo indices agreed with the independently assigned clinical category in 61%, 67% and 47% of cases respectively. Conclusions: Trial recruitment and outcome measures are affected by inter-observer variation in UC activity indices, and endoscopic scoring was the component most susceptible to variation. © 2013.
Authors & Co-Authors
Walsh, Alissa
Australia, Sydney
St. Vincent's Hospital Sydney
Ghosh, A.
United Kingdom, Oxford
University of Oxford
Brain, A. O.
United Kingdom, Oxford
John Radcliffe Hospital
Buchel, Otto
South Africa, Bloemfontein
Universitas Private Hospital
Burger, D.
Australia, Woolloongabba
Princess Alexandra Hospital
Thomas, S.
United Kingdom, Sheffield
The University of Sheffield
White, L.
United Kingdom, Oxford
John Radcliffe Hospital
Collins, Gary S.
United Kingdom, Oxford
University of Oxford Medical Sciences Division
Keshav, Satish
United Kingdom, Oxford
John Radcliffe Hospital
Travis, Simon P.L.
United Kingdom, Oxford
John Radcliffe Hospital
Statistics
Citations: 104
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1016/j.crohns.2013.09.010
ISSN:
18739946
e-ISSN:
18764479
Research Areas
Health System And Policy