Truelove and Witts Severity Index for Ulcerative Colitis

Truelove and Witts Severity Index
Bloody Stools per Day
Pulse
Temperature
Hemoglobin
ESR
Severity: Mild
Mild
Mild UC flare: Most criteria in mild range. Oral 5-ASA or topical therapy may be appropriate.
Stratifies severity of ulcerative colitis.

Why Use

Assists in deciding appropriate management strategies for ulcerative colitis and tracking treatment response. Provides a standardized method to assess disease severity, which can improve communication between clinicians and ensure consistency in patient care.

When to Use

Use at initial diagnosis to establish the severity of ulcerative colitis in adults Apply during follow-up visits to monitor changes in disease activity. Can be used to assess disease severity during acute exacerbations.

Formula

Diagnosis is mild when all six criteria are satisfied. Diagnosis is severe when criteria for frequency of bowel movement and ≥1 features of systemic upset (bolded) are satisfied. Diagnosis is moderate when variables fall between these criteria. Variable Severity of ulcerative colitis Mild Moderate Severe Bowel movements per day <4 4-5 ≥6 Blood in stool None or no more than small amounts of blood Between mild and severe Visible blood Pyrexia * No No Yes Pulse >90 bpm No No Yes Anemia ** No No Yes Erythrocyte sedimentation rate , mm/hr ≤30 >30 *Defined as temperature ≥100.04°F (37.8°C). **Defined as hemoglobin ≤10.5 g/dL (105 g/L).

Pearls / Pitfalls

Some criteria, such as the presence of blood in stool, can be subjective and vary between observers.

Management

Potential induction treatments based on disease activity: Mild disease: Typically managed with aminosalicylates; outpatient follow-up is appropriate. Moderate disease: May require oral or intravenous corticosteroids and immunomodulators, with closer monitoring. Severe disease: Can necessitate hospital admission, corticosteroid therapy, biologic treatments, and consideration for surgical intervention if there is no response to medical therapy. Management should also consider disease extent, clinical scenario, and patient-specific risk factors. Consultation with a gastroenterologist is recommended.

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