General well-being | |
Very well | 0 |
Slightly below par | 1 |
Poor | 2 |
Very poor | 3 |
Terrible | 4 |
Subtotal | |
Abdominal pain | |
None | 0 |
Mild | 1 |
Moderate | 2 |
Severe | 3 |
Subtotal | |
No. of liquid or soft stools per day | |
Subtotal | |
Additional manifestations | |
None | 0 |
Arthralgia | 1 |
Uveitis | 1 |
Erythema nodosum | 1 |
Aphthous ulcer | 1 |
Pyoderma gangrenosum | 1 |
Anal fissure | 1 |
New fistula | 1 |
Abscess | 1 |
Subtotal | |
Abdominal mass Was examination for abdominal mass performed? | |
No: provide SUBSCORE only at end | |
Yes: provide SUBSCORE and TOTAL at end | |
None | 0 |
Dubious | 1 |
Definite | 2 |
Definite and tender | 3 |
Subtotal | |
SUBSCORE (without abdominal examination) | |
TOTAL score (sum of all subtotals) | |