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Truelove & Witts Criteria

Truelove & Witts Severity Criteria

Classifies UC as mild, moderate, or severe. Acute Severe UC (ASUC) = ≥ 6 bloody stools/day + at least 1 systemic feature. Requires immediate hospitalisation and IV corticosteroids. Oxford 1955.

Bloody Stools per Day

Pulse Rate

Temperature

Haemoglobin

ESR

CRP (BSG 2019 addition)

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Immediate triage of patients presenting with an acute flare of Ulcerative Colitis (UC)

To identify "Acute Severe Ulcerative Colitis" (ASUC), a medical emergency requiring hospitalization

To guide the initiation of intravenous (IV) corticosteroid therapy

The Essential 6

The criteria focus on the intersection of objective systemic inflammation (ESR/Pulse/Fever/Hb) and patient-reported bowel habits.

Section 2

Formula & Logic

The Admission Definition (ASUC)

Stool Frequency: ≥ 6 bloody stools per day.

AND at least one of the following:

Pulse > 90 bpm.

Temperature > 37.8°C.

Haemoglobin < 10.5 g/dL.

ESR > 30 mm/h (or high CRP).

Severity Categories

Mild	< 4 stools/day; No systemic features.
Moderate	4–6 stools/day; Mild systemic features.
Severe (ASUC)	≥ 6 bloody stools + Systemic feature.

Section 3

Pearls/Pitfalls

Mortality Transformation

Before Truelove and Witts proved the efficacy of corticosteroids in 1955, the mortality rate for acute severe colitis was ~30%. Today, with standardized management based on these criteria, mortality is < 1%. These remain the most important criteria for saving lives in UC.

ASUC — A Medical Emergency

Patients meeting the "Severe" definition MUST be hospitalized for IV steroids. Outpatient management has a high failure rate in this group and risks delay in surgery for toxic megacolon.

Clinical Pearls

CRP is now often substituted for ESR in many modern centers ($>30$ mg/L)

The presence of "Visible Blood" is a mandatory component of the "Severe" definition

Always perform a plain abdominal radiograph on admission to look for colonic dilatation (Toxic Megacolon)

Section 4

Next Steps

Acute Management Protocol

ASUC Met: Admit; IV Hydrocortisone (100mg QID) or Methylprednisolone (60mg daily); C. diff and CMV testing.

Oxford Predictor (Day 3): If stools > 8 or CRP > 45 on Day 3, initiate rescue biologicals (Infliximab).

Complementary Scoring

Oxford (Travis) Criteria (Day 3 Response)

Full Mayo Score (Endoscopic)

Montreal Classification (Extent)

Section 5

Evidence Appraisal

The Foundational System

Cortisone in ulcerative colitis; final report on a therapeutic trial.

Truelove SC et al. • British Medical Journal. 1955;2(4947):1041-8. The landmark trial that defined the categories and proved steroid benefit.

View Source

Section 6

Literature

Sidney Truelove

Professor Sidney Truelove was a pioneer of the randomized controlled trial (RCT) in medicine. His study at Oxford was one of the first double-blind placebo-controlled trials ever conducted, setting the standard for all subsequent IBD research.

Last Comprehensive Review: 2026

Related Gastroenterology Tools

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AIMS65 Score

Forrest Classification

Rockall Score

Ranson Criteria

BISAP Score

Harvey-Bradshaw Index

Crohn's Disease Activity Index

Mayo Score

Adenoma Detection Rate

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