How it's calculated
Classifies ulcerative colitis severity as mild, moderate, or severe based on bowel frequency, presence of blood, and systemic toxicity signs (fever, tachycardia, anaemia, raised ESR).
Classification criteria
| Mild | Severe | |
|---|---|---|
| Bowel movements/day | <4 | ≥6, with blood |
| Systemic toxicity | None | At least 1 of: fever >37.8°C, pulse >90, Hb <10.5 g/dL, ESR >30 mm/hr |
Moderate disease falls between these two — meeting neither the full mild nor full severe criteria.
Clinical use
- Severe disease generally warrants hospital admission and IV corticosteroids, with consideration of rescue therapy (e.g. infliximab or ciclosporin) if there's no response within days.
- Mild disease is often manageable as an outpatient with oral/topical 5-ASA therapy.
- One of the oldest and still most widely used severity indices in ulcerative colitis, despite newer composite indices also being available.
Frequently asked questions
What is the Truelove and Witts index used for?
It classifies the severity of an ulcerative colitis flare as mild, moderate, or severe, based on bowel frequency, blood in stool, and systemic toxicity signs, guiding the intensity of treatment.
What defines severe ulcerative colitis on this index?
Six or more bloody bowel movements per day, plus at least one sign of systemic toxicity — fever, tachycardia, anaemia, or a raised ESR.
What happens with severe disease that doesn't respond to steroids?
Rescue therapy (such as infliximab or ciclosporin) is generally considered if there's no meaningful response to IV corticosteroids within about 3 days, per most institutional protocols — this decision should involve gastroenterology input.
References
- Truelove SC, Witts LJ. Cortisone in ulcerative colitis: final report on a therapeutic trial. Br Med J. 1955;2:1041-1048.