Appraisal of the pediatric ulcerative colitis activity index (PUCAI).
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.
Turner
Dan
D
Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. turnerd@szmc.org.il
Hyams
Jeffrey
J
Markowitz
James
J
Lerer
Trudy
T
Mack
David R
DR
Evans
Jonathan
J
Pfefferkorn
Marian
M
Rosh
Joel
J
Kay
Marsha
M
Crandall
Wallace
W
Keljo
David
D
Otley
Anthony R
AR
Kugathasan
Subra
S
Carvalho
Ryan
R
Oliva-Hemker
Maria
M
Langton
Christine
C
Mamula
Petar
P
Bousvaros
Athos
A
LeLeiko
Neal
N
Griffiths
Anne M
AM
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