Input Day 3 clinical findings to visualize the steroid response projection.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Prognostic assessment of patients hospitalized with Acute Severe Ulcerative Colitis (ASUC)
Early identification (on Day 3 of IV steroids) of patients failing medical therapy
Triggering the transition to "Rescue Therapy" (Infliximab or Ciclosporin) or surgical evaluation (Colectomy)
Acute Severe UC (ASUC)
The criteria are applied specifically to patients meeting the Truelove and Witts definition of ASUC (≥ 6 bloody stools/day + at least one systemic feature like tachycardia, fever, or high CRP).
Section 2
Formula & Logic
The Day 3 Assessment
Clinical failure is assessed precisely on the 3rd day of administration of high-dose intravenous corticosteroids (e.g., Methylprednisolone 60mg or Hydrocortisone 400mg).
Thresholds for Failure
Stool frequency > 8 per day OR
Stool frequency 3–8 per day AND CRP > 45 mg/L
Predictive Value
Criteria Met (Failure)
85% probability of requiring colectomy
Criteria Not Met
Continue steroid taper; lower risk of immediate surgery
Section 3
Pearls/Pitfalls
Avoiding "The Point of No Return"
The Oxford criteria were developed to prevent delayed surgery in patients who are biologically refractory to steroids. Delaying rescue therapy or colectomy beyond 3–5 days in non-responders is associated with a significantly higher risk of surgical complications and mortality.
The Swedish (Ho) Variation
The Swedish criteria (Ho et al.) also incorporate radiological findings (distended colon > 5.5 cm) and lower albumin, which can further refine the Day 3 prediction.
Clinical Pearls
The predictive power remains robust even in the "Biological era"
Screening for C. difficile and CMV should be performed IMMEDIATELY on admission to ensure "refractory" disease is not actually an untreated infection
If Oxford criteria are met, a decision for "Rescue" (Infliximab/Ciclosporin) must be made by Day 4–5
Section 4
Next Steps
Escalation Protocol
01
Failure on Day 3: Inform Colorectal Surgery; initiate Infliximab (5-10mg/kg) or Ciclosporin (2mg/kg IV).
02
Signs of Toxicity: Immediate Colectomy if toxic megacolon or perforation detected.
Complementary Tools
Truelove and Witts Criteria (ASUC)
Mayo Endoscopic UC Score
Montreal Classification (UC)
Section 5
Evidence Appraisal
The Foundational Paper
Predicting outcome in severe ulcerative colitis.
Travis SP et al. • Gut. 1996;38(6):905-10. The landmark study establishing the "Day 3" rule.
Developed by Professor Simon Travis and colleagues at the Oxford IBD center. Oxford has been the historical center for UC research since the 1950s (starting with Truelove), and these criteria represent the culmination of decades of systematic observation of the "steroid-refractory" phenotype.
