Apply the Day 3 clinical findings to visualize the steroid failure risk profile.
Guidelines & Evidence
Clinical Details
Section 1
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.
Section 2
Formula & Logic
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
Section 3
Pearls/Pitfalls
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
Section 4
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
Section 5
Evidence Appraisal
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.
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.
