Development, Validation, and Evaluation of a Pediatric Ulcerative Colitis Activity Index: A Prospective Multicenter Study

Dan Turner, Anthony R. Otley, David Mack, Jeffrey Hyams, J. de Bruijne, Krista Uusoue, Thomas D. Walters, Mary Zachos, Petar Mamula, Dorcas E. Beaton, A. Hillary Steinhart, Anne M. Griffiths*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

825 Scopus citations

Abstract

Background & Aims: Colonoscopic appearance, the primary measure of disease activity in adult ulcerative colitis, is less acceptable to children. Our aim was to develop a noninvasive activity index of pediatric ulcerative colitis. Methods: Item selection was performed judgmentally using a Delphi group of 36 experts in pediatric inflammatory bowel disease. Item weighting was performed by regression modeling using a prospective cohort of 157 pediatric ulcerative colitis patients. Validation was assessed on a separate prospective cohort of 48 children with ulcerative colitis undergoing complete colonoscopy. Responsiveness was evaluated at a follow-up visit of 75 children using effect size statistics and diagnostic utility approaches. Results: A list of 41 items was generated and reduced to 11 by rank order. Two physicians completed the Pediatric Ulcerative Colitis Activity Index (PUCAI) on each of the patients in the weighting cohort. Six clinical items were significant in the regression analysis; the laboratory items and an endoscopic appearance item did not improve the PUCAI performance. In the validation cohort, the PUCAI was highly correlated with the Physician's Global Assessment (r = 0.91, P < .001), Mayo score (r = 0.95, P < .001), and colonoscopic appearance (r = 0.77, P < .001). Correlations were higher than 2 noninvasive adult indices calculated concurrently. Interobserver and test-retest reliability were excellent (intraclass correlation coefficient = 0.95; 95% CI: 0.93-0.97). Cut-off points were established using receiver operator characteristic curves on the full cohort. Excellent responsiveness was found at repeated visits (effect size = 1.9, area under the receiver operator characteristic curve = 0.97). Conclusions: The rigorously developed PUCAI is a noninvasive, valid, highly reliable, and responsive index with which to assess disease activity in pediatric ulcerative colitis.

Original languageAmerican English
Pages (from-to)423-432
Number of pages10
JournalGastroenterology
Volume133
Issue number2
DOIs
StatePublished - Aug 2007
Externally publishedYes

Bibliographical note

Funding Information:
Supported by a research fellowship stipend (to D.T.) from the Canadian Institute of Health Research/Canadian Association of Gastroenterology/Crohn’s and Colitis Foundation of Canada.

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