Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI)

Dan Turner, Jeffrey Hyams, James Markowitz, Trudy Lerer, David R. Mack, Jonathan Evans, Marian Pfefferkorn, Joel Rosh, Marsha Kay, Wallace Crandall, David Keljo, Anthony R. Otley, Subra Kugathasan, Ryan Carvalho, Maria Oliva-Hemker, Christine Langton, Petar Mamula, Athos Bousvaros, Neal LeLeiko, Anne M. Griffiths

Research output: Contribution to journalArticle

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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). Conclusion: This study on real-life, prospectively obtained data confirms that the PUCAI is highly feasible by virtue of the non-invasiveness, valid, and responsive index. The PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric UC.

Original languageEnglish (US)
Pages (from-to)1218-1223
Number of pages6
JournalInflammatory bowel diseases
Volume15
Issue number8
DOIs
StatePublished - Oct 5 2009

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Confidence Intervals
Area Under Curve
Pediatric ulcerative colitis
Ulcerative Colitis
Psychometrics
Reproducibility of Results
ROC Curve
Crohn Disease
Registries
Odds Ratio
Outcome Assessment (Health Care)
Databases
Pediatrics
Physicians
Therapeutics
Research
Pediatric Crohn's disease

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Gastroenterology

Cite this

Turner, D., Hyams, J., Markowitz, J., Lerer, T., Mack, D. R., Evans, J., ... Griffiths, A. M. (2009). Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI). Inflammatory bowel diseases, 15(8), 1218-1223. https://doi.org/10.1002/ibd.20867
Turner, Dan ; Hyams, Jeffrey ; Markowitz, James ; Lerer, Trudy ; Mack, David R. ; Evans, Jonathan ; Pfefferkorn, Marian ; Rosh, Joel ; Kay, Marsha ; Crandall, Wallace ; Keljo, David ; Otley, Anthony R. ; Kugathasan, Subra ; Carvalho, Ryan ; Oliva-Hemker, Maria ; Langton, Christine ; Mamula, Petar ; Bousvaros, Athos ; LeLeiko, Neal ; Griffiths, Anne M. / Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI). In: Inflammatory bowel diseases. 2009 ; Vol. 15, No. 8. pp. 1218-1223.
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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). Conclusion: This study on real-life, prospectively obtained data confirms that the PUCAI is highly feasible by virtue of the non-invasiveness, valid, and responsive index. The PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric UC.",
author = "Dan Turner and Jeffrey Hyams and James Markowitz and Trudy Lerer and Mack, {David R.} and Jonathan Evans and Marian Pfefferkorn and Joel Rosh and Marsha Kay and Wallace Crandall and David Keljo and Otley, {Anthony R.} and Subra Kugathasan and Ryan Carvalho and Maria Oliva-Hemker and Christine Langton and Petar Mamula and Athos Bousvaros and Neal LeLeiko and Griffiths, {Anne M.}",
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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 2009, 'Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI)', Inflammatory bowel diseases, vol. 15, no. 8, pp. 1218-1223. https://doi.org/10.1002/ibd.20867

Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI). / Turner, Dan; Hyams, Jeffrey; Markowitz, James; Lerer, Trudy; Mack, David R.; Evans, Jonathan; Pfefferkorn, Marian; Rosh, Joel; Kay, Marsha; Crandall, Wallace; Keljo, David; Otley, Anthony R.; Kugathasan, Subra; Carvalho, Ryan; Oliva-Hemker, Maria; Langton, Christine; Mamula, Petar; Bousvaros, Athos; LeLeiko, Neal; Griffiths, Anne M.

In: Inflammatory bowel diseases, Vol. 15, No. 8, 05.10.2009, p. 1218-1223.

Research output: Contribution to journalArticle

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T1 - Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI)

AU - Turner, Dan

AU - Hyams, Jeffrey

AU - Markowitz, James

AU - Lerer, Trudy

AU - Mack, David R.

AU - Evans, Jonathan

AU - Pfefferkorn, Marian

AU - Rosh, Joel

AU - Kay, Marsha

AU - Crandall, Wallace

AU - Keljo, David

AU - Otley, Anthony R.

AU - Kugathasan, Subra

AU - Carvalho, Ryan

AU - Oliva-Hemker, Maria

AU - Langton, Christine

AU - Mamula, Petar

AU - Bousvaros, Athos

AU - LeLeiko, Neal

AU - Griffiths, Anne M.

PY - 2009/10/5

Y1 - 2009/10/5

N2 - 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). Conclusion: This study on real-life, prospectively obtained data confirms that the PUCAI is highly feasible by virtue of the non-invasiveness, valid, and responsive index. The PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric UC.

AB - 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). Conclusion: This study on real-life, prospectively obtained data confirms that the PUCAI is highly feasible by virtue of the non-invasiveness, valid, and responsive index. The PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric UC.

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Turner D, Hyams J, Markowitz J, Lerer T, Mack DR, Evans J et al. Appraisal of the Pediatric Ulcerative Colitis Activity Index (PUCAI). Inflammatory bowel diseases. 2009 Oct 5;15(8):1218-1223. https://doi.org/10.1002/ibd.20867