What Is a PUCAI Score?

Medically Reviewed by Sabrina Felson, MD on May 31, 2024
4 min read

Living with pediatric ulcerative colitis (UC) means your child may go through sudden shifts from minor to no symptoms to severe symptoms. They may need regular monitoring and long-term care. The Pediatric Ulcerative Colitis Activity Index (PUCAI) score may help predict these shifts and manage symptoms.

The PUCAI score is a simple, noninvasive tool that tells a doctor how mild or severe your child’s UC symptoms are. It also tells them more about their response to treatments. Here’s what you need to know about the PUCAI score and how to calculate it.

A PUCAI score is a number that tells how serious your child’s symptoms are. Doctors reach this number by using a scoring system for measuring the extent and severity of UC in children without taking a lab test.

The doctor listens to your child’s or your report of their symptoms and translates them into the PUCAI. The PUCAI takes less than a minute to calculate and can be used to monitor symptoms in both adults and children.

Based on typical symptoms, the PUCAI looks at six items to arrive at a score:

  1. Abdominal pain
  2. Rectal bleeding
  3. Stool consistency
  4. Stool frequency
  5. Bathroom visits that disrupt sleep
  6. Activity level

Endoscopy is a test that looks at a person’s digestive tract using a flexible tube with a special camera. However, because of its cost and the invasive nature of endoscopy, it’s not always a good choice for monitoring UC in children.

Researchers created the PUCAI score in 2007 as a substitute for endoscopy. Since then, researchers have used the PUCAI in studies to measure how well people respond to UC medicines. Studies have found that the PUCAI is also useful in hospital settings to help manage UC in children.

Doctors can use the PUCAI to monitor a child’s symptoms and response to treatment. They can also use it to predict and manage complications and emergency cases.

But can you or your child complete the PUCAI? A 2011 study showed PUCAI scores calculated by doctors were similar to those calculated by their patients, especially those with moderate to severe symptoms.

There was less – but still high – agreement between patient-completed and doctor-completed PUCAI scores when the patients had little or no symptoms.

The researchers said that patient-based PUCAI tools could be useful for helping them be more aware of their symptoms and communicate with their doctors. Still, the study showed that scores calculated by doctors and patients do not always agree, so a patient-based PUCAI score can’t replace a doctor’s evaluation.

The PUCAI can be a valuable tool to help you monitor your child’s symptoms and know when to seek medical help. But it’s always best to see a doctor if you notice any changes in symptoms or would like to know their progress with treatment.

The PUCAI score ranges from 0 to 85 and is defined as:

  • Remission (having very little or no symptoms): less than 10
  • Mild: 10-34
  • Moderate: 35-64
  • Severe: 65 or above

This table shows how to calculate the score:

Abdominal pain

No pain = 0

Pain can be ignored = 5

Pain cannot be ignored = 10

Rectal bleeding

None = 0

Small amount only, in less than 50% of stools = 10

Small amount with most stools = 20

Large amount (50% of the stool content) = 30

Stool consistency (the firmness) of most stools

Formed = 0

Partially formed = 5

Completely unformed = 10

Number of stools per 24 hours

0-2 = 0 points

3-5 = 5 points

6-8 = 10 points

More than 8 = 15 points

Stools that cause you to wake up at night

No = 0 points

Yes = 10 points

Activity level

No limit on activity = 0

Some limit on activity = 5

Most activity is not possible = 10

 Sum of PUCAI (0-85)

The PUCAI score can help a doctor:

  • Monitor symptom changes
  • Predict when your child needs urgent care
  • Choose the best treatment after diagnosis
  • Predict whether your child will need a colectomy, a surgery to remove the entire colon
  • Predict response to treatment
  • Predict the course of the disease over time
  • Know when to recommend other treatments in severe cases

Experts recommend that doctors check a child’s PUCAI score during every visit and reevaluate treatment if their score is above 10.

About 20%-30% of people with UC will have a PUCAI score of 65 or above at some point in time. If your child’s PUCAI score is 65 or above, they show serious UC symptoms that could mean acute severe ulcerative colitis, a life-threatening UC complication.

Doctors would treat it as a medical emergency requiring quick intervention to avoid further complications like a ruptured bowel, blood infection, or possibly death. They may refer your child to a pediatric gastroenterology unit with surgical support.

A PUCAI score is reliable for monitoring UC symptoms in children. Although you can calculate your child’s PUCAI score when they tell you their symptoms, it’s best to see a doctor for symptom evaluation and treatment progress. Also, contact a doctor if you calculate your child’s PUCAI and they score 65 and above.