Oxford Criteria • Day 3 Steroid Assessment
Apply the Day 3 clinical findings to visualize the steroid failure risk profile.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
Prognostic assessment of patients hospitalized with Acute Severe Ulcerative Colitis (ASUC)
Standardized decision support on Day 3 of high-dose intravenous steroids
To trigger the transition to biological rescue or surgical evaluation
Philosophy of the Criteria
The "Oxford" or "Travis" criteria provide a high-confidence prediction of steroid failure. Early recognition of non-response is critical to avoid the morbidity of delayed surgery.
How it Works
The Day 3 Assessment (The Rule)
01
Condition: Patient must be on high-dose IV steroids (e.g., Methylprednisolone 60mg).
02
Positive for Failure if: Stool frequency > 8 / day.
03
Positive for Failure if: Stool frequency 3–8 / day AND CRP > 45 mg/L.
Predictive Performance
| PPV for Colectomy | 85% (at original study admission) |
| Sensitivity | High for Identifying non-responders |
Clinical Pearls
The "Biological Era" Perspective
Despite the arrival of Infliximab, the Oxford criteria remain valid. If a patient meets these criteria, simple "more steroids" will almost never work. The clinician must either "Rescue" (Infliximab/Ciclosporin) or "Colectomize."
CRP vs. Stool Frequency
Stool frequency is the more heavily weighted component. A patient with 12 bloody stools and a normal CRP is still a high-risk failure under the Oxford protocol.
Clinical Pearls
The criteria should be assessed exactly at 72 hours (Day 3) post-steroid initiation
Always exclude toxic megacolon (X-ray showing transverse colon > 5.5 cm) before considering IV rescue
Concurrent CMV and C. diff testing must be completed by Day 3 to ensure the "failure" is purely inflammatory
Next Steps
Escalation Protocol
01
Criteria Met: Initiate rescue therapy (Infliximab 5-10 mg/kg or Ciclosporin 2 mg/kg) WITHIN 24 hours.
02
Criteria Not Met: Continue steroids; consider shift to oral Prednisone if stools drop to < 3 consistently.
Related Scoring Tools
Lichtiger Index (Daily Monitoring)
Truelove and Witts Criteria (Admission Criteria)
Mayo Endoscopic UC Score
The Evidence
The Landmark Study
Predicting outcome in severe ulcerative colitis.
Travis SP et al. • Gut. 1996;38(6):905-10. Establishing the canonical Day 3 rule.
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Origins & History
Oxford IBD Group
Developed by Professor Simon Travis at the John Radcliffe Hospital. It reflects the Oxford tradition of systematic data collection in IBD, a lineage starting with Truelove’s first randomized trials of steroids in the 1950s.
Last Comprehensive Review: 2026-07-17