Gastroenterology
Harvey-Bradshaw Index (HBI)
Assess clinical symptom activity in Crohn’s disease using the standard five-item Harvey-Bradshaw Index.
Calculator
Enter symptoms for the previous day. Select every complication that applies.
Important: Use this calculator only as part of a clinician-led assessment. Urgent symptoms or concern for complications should be assessed promptly through the appropriate clinical pathway.
Reference: Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet. 1980;1(8167):514.
The Harvey-Bradshaw Index (HBI) is a simplified clinical tool used to quantify the disease activity of Crohn’s Disease. Devised in 1980 by Richard Harvey and Stephen Bradshaw, it was designed as a more practical alternative to the cumbersome Crohn’s Disease Activity Index (CDAI) (Harvey & Bradshaw, 1980).
While the CDAI requires patients to keep a detailed seven-day diary of symptoms, the HBI can be completed during a single clinical encounter, making it the "gold standard" for rapid bedside assessment and long-term outpatient monitoring.
The Five Components of the HBI
The index consists of five clinical parameters based on the patient's status from the previous day. Unlike other gastrointestinal scores, it does not require laboratory data or endoscopic findings for the basic calculation.
1. General Well-being (0–4)
The patient rates how they felt yesterday:
- 0: Very well
- 1: Slightly below par
- 2: Poor
- 3: Very poor
- 4: Terrible
2. Abdominal Pain (0–3)
- 0: None
- 1: Mild
- 2: Moderate
- 3: Severe
3. Number of Liquid Stools (Point per bowel movement)
The patient records the number of liquid or very soft stools passed in the previous 24 hours. (e.g., 5 stools = 5 points).
4. Abdominal Mass (0–3)
This is the only component requiring a physical examination by a clinician:
- 0: None
- 1: Dubious
- 2: Definite
- 3: Definite and tender
5. Complications (1 point per complication)
The clinician checks for the presence of "extra-intestinal manifestations" or specific local complications:
- Arthralgia (joint pain)
- Uveitis (eye inflammation)
- Erythema nodosum or Pyoderma gangrenosum (skin lesions)
- Aphthous ulcers (mouth sores)
- Anal fissures, fistulae, or abscesses
Clinical Interpretation and Scoring
The total score provides a snapshot of whether the disease is controlled or flaring.
| HBI Score | Disease Activity | Clinical Status |
| < 5 | Remission | Disease is well-controlled. |
| 5 – 7 | Mild | Early signs of a flare; may require medication adjustment. |
| 8 – 16 | Moderate | Significant impact on daily life; active inflammation likely. |
| > 16 | Severe | High risk of hospitalization or surgical intervention. |
HBI vs. CDAI: Which is better?
The primary advantage of the HBI is feasibility. Correlation studies have shown a very high degree of agreement ($r = 0.93$) between the HBI and the more complex CDAI (Best, 2006).
However, because the HBI relies heavily on the "number of liquid stools," it can sometimes be misleading in patients who have had significant bowel resections or those with co-existing Irritable Bowel Syndrome (IBS), where high stool frequency may not always indicate active Crohn's inflammation. In these cases, clinicians often supplement the HBI with objective markers like Fecal Calprotectin or C-Reactive Protein (CRP).
References
- Harvey, R. F., & Bradshaw, J. M. (1980). A simple index of Crohn's-disease activity. The Lancet, 315(8167), 514-515. https://doi.org/10.1016/S0140-6736(80)91049-3
- Best, W. R. (2006). Predicting the Crohn's disease activity index from the Harvey-Bradshaw index. Clinical Gastroenterology and Hepatology, 4(3), 356-359.
- Vermeire, S., et al. (2002). The use of C-reactive protein as a predictor of drug response with infliximab in Crohn's disease. Alimentary Pharmacology & Therapeutics.
- Satsangi, J., et al. (2006). The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut, 55(6), 749-753.
