Pediatric Ulcerative Colitis Activity Index (PUCAI)

Evaluates UC activity and response to treatment in children with chronic inflammatory bowel disease.

Refer to the text below the calculator for more information on the index, score interpretation, its development and validation.


PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric ulcerative colitis in routine clinical settings. There is extensive evidence to support its validity and responsiveness from studies on diverse pediatric gastroenterology practices.


PUCAI scores range from 0 to 85 and are interpreted as follows:

PUCAI score UC disease severity
0 – 9 Remission
10 – 34 Mild disease
35 – 64 Moderate disease
65 – 85 Severe disease

Scores of 10 or more require a re-evaluation of treatment. In 20-30% cases, at some point in time, a PUCAI score of 65 may be reached, and that is acute severe ulcerative colitis, a life-threatening complication.


1

Abdominal pain

2

Rectal bleeding

3

Stool consistency of most stools

4

Number of stools per 24 hours

5

Nocturnal bowel movement (any diarrhea episode causing wakening)

6

Activity level

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PUCAI score explained

Children living with ulcerative colitis may need regular monitoring and long-term care, with periods varying from no symptoms to others with severe symptoms. The PUCAI is a rapid, non-invasive disease activity index that can help assess UC symptoms and response to therapy, without the need to employ more invasive means, such as endoscopy.

PUCAI Score Points
Abdominal pain No pain 0
Pain can be ignored 5
Pain cannot be ignored 10
Rectal bleeding None 0
Small amount only, in less than 50% of stools 10
Small amount with most stools 20
Large amount (>50% of the stool content 30
Stool consistency of most stools Formed 0
Partially formed 5
Completely formed 10
Number of stools per 24 hours 0 – 2 0
3 – 5 5
6 – 8 10
>8 15
Nocturnal bowel movement (any diarrhea episode causing wakening) No 0
Yes 10
Activity level No limitation of activity 0
Occasional limitation of activity 5
Severely restricted activity 10

This index is regularly used to not only monitor symptoms and response to treatment but also predict and manage complications and can be employed by both clinicians and parents.

PUCAI scores range from 0 to 85 and are interpreted as follows:

PUCAI score UC disease severity
0 – 9 Remission
10 – 34 Mild disease
35 – 64 Moderate disease
65 – 85 Severe disease

Scores of 10 or more require a re-evaluation of treatment. In 20-30% cases, at some point in time, a PUCAI score of 65 may be reached, and that is acute severe ulcerative colitis, a life-threatening complication. This medical emergency requires quick intervention to avoid a ruptured bowel, blood infection or more severe complications.

The FDA endorsed the PUCAI for replacing endoscopic assessment for the first-line diagnosis in a pediatric trial consisting of a 5-aminosalicylate (5-ASA) regimen.

The PUCAI is apt for prolonged use in clinical trials and for predicting accurately severe acute UC when introducing second-line therapy.

 

About the original study and validations

Turner et al. developed a non-invasive activity index of pediatric ulcerative colitis following a study on a cohort of 157 pediatric patients. A Delphi group of 36 experts in pediatric inflammatory bowel disease selected 41 items, of which 11 were applied to each of the patients in the weighting cohort.

Six clinical items, which now make up the PUCAI, were found significant in the regression analysis. Validation was assessed on a separate prospective cohort of 48 children with ulcerative colitis undergoing complete colonoscopy.

In the validation cohort, the PUCAI was highly correlated with the Physician's Global Assessment (r = 0.91, P < .001), Mayo score (r = 0.95, P < .001), and colonoscopic appearance (r = 0.77, P < .001).

Cut-off points were established using receiver operator characteristic curves on the full cohort.

A further appraisal of the index found that the best cutoff to differentiate remission from active disease was 10 points (AUC 0.94; 95% CI 0.90-0.97). Test-retest reliability was excellent (intraclass correlation coefficient = 0.89; 95% CI 0.84-0.92, P < 0.001) as well as responsiveness to change (AUC 0.96 [0.92-0.99]; standardized response mean 2.66).

 

References

Original reference

Turner D, Otley AR, Mack D, Hyams J, de Bruijne J, Uusoue K, Walters TD, Zachos M, Mamula P, Beaton DE, Steinhart AH, Griffiths AM. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007; 133(2):423-32.

Validation

Dotson JL, Crandall WV, Zhang P, Forrest CB, Bailey LC, Colletti RB, Kappelman MD. Feasibility and validity of the pediatric ulcerative colitis activity index in routine clinical practice. J Pediatr Gastroenterol Nutr. 2015; 60(2):200-4.

Turner D, Hyams J, Markowitz J, Lerer T, Mack DR, Evans J, Pfefferkorn M, Rosh J, Kay M, Crandall W, Keljo D, Otley AR, Kugathasan S, Carvalho R, Oliva-Hemker M, Langton C, Mamula P, Bousvaros A, LeLeiko N, Griffiths AM; Pediatric IBD Collaborative Research Group. Appraisal of the pediatric ulcerative colitis activity index (PUCAI). Inflamm Bowel Dis. 2009; 15(8):1218-23.


Specialty: Pediatrics

System: Digestive

Objective: Stratification

Type: Index

No. Of Items: 6

Year Of Study: 2007

Abbreviation: PUCAI

Article By: Denise Nedea

Published On: May 13, 2024

Last Checked: May 13, 2024

Next Review: May 13, 2029