Pediatric Ulcerative Colitis Activity Index (PUCAI)
Determines severity of ulcerative colitis (UC) in pediatric patients.
- In general, provide answers as the average of the past 2 days.
- If the child’s status is rapidly evolving, use the most recent 24 hours.
- If the child is undergoing colonoscopy, score the 2 days before bowel cleanout began.
Advice
- This tool should be used alongside laboratory tests and, when indicated, endoscopy to guide management.
- Aim for complete symptom resolution (score <10).
- A score ≥65 at 3 days of IV steroids predicts high colectomy risk and warrants early escalation or surgical consultation.
Management
- Remission (score <10): Maintenance management will depend on the therapy used to achieve remission and the patient’s clinical response to tapering.
- Mild UC (score 10–34): Oral +/- rectal 5-aminosalicylate therapy may be appropriate.
- Moderate UC (score 34–64): Systemic corticosteroids or biologics may be needed.
- Severe UC (score ≥ 65):
- Hospitalization is usually required for supportive care (e.g., hydration, nutrition, pain management), intravenous corticosteroids, and antibiotics (in selected patients).
- Steroid-resistant disease may require “rescue” therapy (e.g., biologic agents, anti-TNF agents, calcineurin inhibitors) or colectomy.
Consult local or national treatment guidelines, such as the American College of Gastroenterology, for more detailed recommendations.
Critical Actions
This tool complements, but does not replace, clinical judgment, specialist input, and other diagnostic tools within a comprehensive assessment.