This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Ulcerative colitis is a chronic inflammation of the colon that often starts in childhood or adolescence. To follow a child’s disease and judge whether a treatment works, pediatric gastroenterologists use the Pediatric Ulcerative Colitis Activity Index (PUCAI), developed by Turner and colleagues in 2007. It is non-invasive: it relies only on symptoms, without blood tests or endoscopy.
The six items
| Item | Points |
|---|---|
| Abdominal pain | none 0, can be ignored 5, cannot be ignored 10 |
| Rectal bleeding | none 0, small amount in under 50% of stools 10, small amount with most stools 20, large amount 30 |
| Stool consistency | formed 0, partially formed 5, completely unformed 10 |
| Number of stools in 24 hours | 0 to 2: 0; 3 to 5: 5; 6 to 8: 10; more than 8: 15 |
| Nocturnal stools | no 0, yes 10 |
| Activity level | no limitation 0, occasional limitation 5, severely restricted 10 |
The total ranges from 0 to 85. Items are usually assessed over the previous 48 hours.
Example
A teenager with mild pain that can be ignored, a little blood in fewer than half of the stools, partially formed stools, four stools a day, no night stools and normal activity scores 5 + 10 + 5 + 5 + 0 + 0 = 25: mild activity.
Interpretation
| PUCAI | Disease activity |
|---|---|
| under 10 | remission |
| 10 to 34 | mild |
| 35 to 64 | moderate |
| 65 or more | severe |
A drop of 20 points or more is considered a clinically significant response. In children hospitalized for acute severe colitis, a PUCAI above 45 on day 3 suggests that second-line treatment may be needed, and a PUCAI above 65 on day 5 makes it very likely.
Limits
- The PUCAI measures symptoms; it does not replace endoscopy, which remains the reference for mucosal healing.
- Infections, such as Clostridioides difficile, can mimic a flare and must be excluded.
- It is validated in children and adolescents, not adults, who are usually assessed with the Mayo score.
Any child with blood in the stools, night-time diarrhea or weight loss should be seen by a doctor.