Development and validation of a symptom-based severity score for haemorrhoidal disease: The Sodergren Score. Philip H Pucher, Maria Qurashi, Ann-Marie Howell, Omar Faiz, Paul Ziprin, Ara Darzi and Mikael H Sodergren. Colorectal Disease 2015 .[Epub ahead of print]
One major obstacle in assessing the efficacy of treatment of haemorrhoids and comparison of trials has been the lack of a standardised, validated symptom severity score for haemorrhoids. The study aimed to develop an objective, validated symptom-based score of severity for haemhorrhoids that can be used to compare treatments, monitor disease and assist in surgical decisions.
A symptom and quality of life questionnaire was developed from the literature in conjunction with surgical expert opinion. The questionnaire was circulated to patients with confirmed haemorrhoids. A statistical model was used to derive a weighted score of symptoms most affecting patients’ quality of life. Patients who were offered operative treatment were independently judged by specialists to have more severe symptoms, with further validation of the scoring system against treatment.
45 patients were included in final validation analysis of whom 44 (98%) reported multiple symptoms, the most common being rectal bleeding. Patient-reported effects on quality of life were 47.5±36.3 (1-100 visual analogue scale). Calculated symptom severity scores were used to compare patients receiving operative or ambulatory care, with significant difference in the scores (7.7±3.9 vs. 2.8±3.5, p 0.002) and ROC area-under-curve of 0.842.
A novel validated score for the assessment of haemorrhoidal disease adopting a standardised global score for symptom severity may have important implications in future for research, assessment and management of this common pathology.