title: Appraisal of the pediatric ulcerative colitis activity index (PUCAI).
abstract: BACKGROUND
  We evaluated the psychometric performance of the Pediatric Ulcerative Colitis Activity Index (PUCAI) in a real-life cohort from the Pediatric IBD Collaborative Research Group.
  
  
  METHODS
  Two consecutive visits of 215 children with ulcerative colitis (UC) were included (mean age 11.2 +/- 3.6 years; 112 (52%) males; 63 (29%) newly diagnosed and the others after disease duration of 24 +/- 15.6 months). Validity was assessed using several constructs of disease activity. Distributional and anchor-based strategies were used to assess the responsiveness of the PUCAI to change over time following treatment.
  
  
  RESULTS
  Reflecting feasibility, 97.6% of 770 eligible registry visits had a completed PUCAI score versus only 47.6% for a contemporaneously collected Pediatric Crohn's Disease Activity Index (odds ratio = 45.8, 95% confidence interval [CI] 28.6-73.5) obtained for children with Crohn's disease accessioned into the same database. The PUCAI score was significantly higher in patients requiring escalation of medical therapy (45 points [interquartile range, IQR, 30-60]) versus those who did not, (0 points [IQR 0-10]; P < 0.001), and was highly correlated with physician's global assessment of disease activity (r = 0.9, P < 0.001). The best cutoff to differentiate remission from active disease was 10 points (area under receiver operating characteristic curve [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).
  
  
  CONCLUSIONS
  This study on real-life, prospectively obtained data confirms that the PUCAI is highly feasible by virtue of the noninvasiveness, valid, and responsive index. The PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric UC.
authors.affiliation: Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. turnerd@szmc.org.il
authors.forename: Dan
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authors.lastname: Turner
authors.forename: Jeffrey
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authors.forename: James
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authors.lastname: Markowitz
authors.forename: Trudy
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authors.forename: Jonathan
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authors.lastname: Keljo
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Otley
authors.forename: Subra
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authors.lastname: Kugathasan
authors.forename: Ryan
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authors.lastname: Carvalho
authors.forename: Maria
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authors.lastname: Oliva-Hemker
authors.forename: Christine
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authors.lastname: Langton
authors.forename: Petar
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authors.lastname: Mamula
authors.forename: Athos
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authors.lastname: Bousvaros
authors.forename: Neal
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authors.lastname: LeLeiko
authors.forename: Anne M
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authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011594:Psychometrics; D012042:Registries; D016896:Treatment Outcome