🩺 Truelove-Witts Ulcerative Colitis Severity
The Truelove and Witts criteria classify an acute ulcerative colitis flare as mild, moderate, or severe from bowel and systemic features.
Truelove-Witts Ulcerative Colitis Severity
Stools per day
Blood in stool
Temperature >37.8°C
Heart rate >90 bpm
Hemoglobin <105 g/L
ESR >30 mm/h
When to use
Select daily stool count, rectal bleeding, and four systemic markers; the tool returns the severity category and the number of systemic features present.
How it works
Severe = ≥6 bloody stools/day plus ≥1 of (temp >37.8°C, HR >90 bpm, Hb <105 g/L, ESR >30 mm/h). Mild = <4 stools/day with no systemic features. Otherwise moderate.
Key points
- Acute severe UC meeting the criteria is a medical emergency requiring admission, IV corticosteroids, and surgical co-review (original synthesis · not guideline verbatim).
- The four systemic markers (fever, tachycardia, anemia, elevated ESR) drive the severe classification when combined with frequent bloody stools.
- Failure of IV steroids by day 3 should trigger rescue therapy (infliximab or ciclosporin) or colectomy discussion.
References
- Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report. BMJ. 1955.
- Lamb CA, et al. British Society of Gastroenterology IBD guidelines. Gut. 2019.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.