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Harvey-Bradshaw Index

Harvey-Bradshaw Index (HBI)

Simplified Crohn's Disease Activity Index. No 7-day diary required. Validated vs CDAI (r=0.93). Remission target: HBI < 5.

General Wellbeing

Abdominal Pain

Liquid / Soft Stools per Day

0stools/day = +0 pts

Abdominal Mass

Complications (1pt each)

Arthralgia, uveitis, erythema nodosum, aphthous ulcers, pyoderma, anal fissure, new fistula, abscess

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Clinically practical quantification of Crohn's disease activity during outpatient visits

Evaluating response to therapy in real-time without the need for a 7-day diary

Used in clinical research as a simplified alternative to the CDAI

HBI vs. CDAI

The HBI (1980) was designed specifically to overcome the complexity of the CDAI (1976). It correlates very highly ($r > 0.9$) with the CDAI, but can be performed in minutes during a standard consultation.

Section 2

Formula & Logic

The 5 Clinical Components

General Well-being (0: Very well to 4: Terrible).

Abdominal Pain (0: None to 3: Severe).

Number of Liquid Stools (recorded per day).

Abdominal Mass (0: None to 3: Definite/Tender).

Complications (1 point each for Arthritis, Uveitis, Erythema Nodosum, Aphthous ulcers, Pyoderma, Anal Fissure, Fistula, or Abscess).

Total Score Interpretation

< 5	Clinical Remission
5–7	Mild Activity
8–16	Moderate Activity
> 16	Severe Activity

Section 3

Pearls/Pitfalls

Clinical Remission

The HBI is the standard for defining "Clinical Remission" (< 5) in most post-induction biological trials. However, it is important to remember that HBI targets "Symptom Control" — not necessarily "Mucosal Healing."

The "Subjectivity" Caveat

Like the CDAI, the HBI is heavily weighted toward "Well-being" and "Pain," which can be significantly affected by IBS-overlap, fibromyalgia, or psychiatric comorbidities. Always correlate a high HBI with objective markers (CRP/Calprotectin).

Clinical Pearls

A 3-point decrease in HBI is generally considered a "Clinical Response"

HBI does NOT require laboratory tests (unlike CDAI which requires Haematocrit), making it truly a bedside calculation

In patients with ileostomies, the "Liquid Stools" component should be interpreted as the frequency of bag emptying, but the score is less validated in this group

Section 4

Next Steps

Management Pathways

Score < 5: Clinical Remission. Maintain therapy; monitor objective biomarkers annually.

Score ≥ 8: Moderate/Severe. Escalation trial needed. Confirm with colonoscopy or MRI before switching biologicals.

Complementary Scoring

Crohn's Disease Activity Index (CDAI)

SES-CD (Endoscopic Score)

Harvey-Bradshaw to CDAI Conversion

Section 5

Evidence Appraisal

The Original Index

A simple index of Crohn's-disease activity.

Harvey RF et al. • Lancet. 1980;1(8167):514. The foundational study established as a direct simplification of the NCCDS CDAI.

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Modern Validation Study

Predicting the Crohn's disease activity index from the Harvey-Bradshaw index.

Best WR. • Clinical Gastroenterology and Hepatology. 2006;4(3):304-10. Statistical validation of the HBI-CDAI correlation.

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Section 6

Literature

Harvey and Bradshaw

Developed by R.F. Harvey and J.M. Bradshaw at Frenchay Hospital in Bristol, UK. They recognized that while the CDAI was great for multi-thousand patient trials, it was "too cumbersome" for use in a busy NHS outpatient clinic, leading to the creation of this 5-item bedside standard.

Last Comprehensive Review: 2026

Related Gastroenterology Tools

Glasgow-Blatchford Score

AIMS65 Score

Forrest Classification

Rockall Score

Ranson Criteria

BISAP Score

Crohn's Disease Activity Index

Mayo Score

Truelove & Witts Criteria

Adenoma Detection Rate

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