Children with ulcerative colitis (UC) present with more extensive inflammation than adults, increasing their risk for severe exacerbations.¹ Nearly half of children admitted with exacerbations are corticosteroid refractory and require salvage therapy (including cyclosporine, infliximab, and/or colectomy).² Corticosteroid-refractory disease must therefore be identified quickly to limit complications and adverse medication effects. The Pediatric UC Activity Index (PUCAI) was developed to assess overall disease severity based on pain, rectal bleeding, activity level, stool consistency and frequency, and nocturnal stooling. A score of <10 is remission, 10 to 34 is mild, 35 to 64 is moderate, and 65 to 85 is severe disease.³ This study assessed the utility of the PUCAI to predict steroid-refractory UC.