Healthcare & Clinical
Truelove and Witts Criteria for Acute Severe Ulcerative Colitis (ASUC)
Classify ulcerative colitis flares into Mild, Moderate, or Acute Severe UC (ASUC: >= 6 bloody stools/day plus >= 1 systemic toxicity marker: T > 37.8 °C, HR > 90, Hgb < 10.5 g/dL, or CRP/ESR > 30).
Why a 1955 BMJ bedside rule still defines emergency IV corticosteroid admission in ulcerative colitis!
Published in the very first randomized controlled trial in gastroenterology by Sidney C. Truelove and Leslie J. Witts (BMJ, 1955) and endorsed by modern ECCO, BSG, and ACG guidelines, Acute Severe Ulcerative Colitis (ASUC) is a medical-surgical emergency defined by >= 6 bloody stools per day PLUS at least ONE of four objective systemic toxicity markers: Temperature > 37.8 °C, Heart rate > 90 bpm, Hemoglobin < 10.5 g/dL, or ESR > 30 mm/h (or CRP > 30 mg/L in contemporary ECCO/BSG practice)!
Furthermore, every additional systemic toxicity criterion on admission multiplies colectomy risk (< 10% with 1 marker vs. ~40–50% when >= 3 markers accompany >= 6 bloody stools/day), mandating immediate inpatient IV hydrocortisone/methylprednisolone, VTE prophylaxis, abdominal X-ray, and joint gastroenterology–colorectal surgery Day-3 rescue monitoring!
| Truelove & Witts Severity Tier | Bloody Stools / Day | Systemic Toxicity Markers (0–4) | Inpatient Management |
|---|---|---|---|
| Mild Flare | < 4 stools/day | 0 markers (Afebrile, Normal HR/Hgb/CRP) | Outpatient Oral/Rectal 5-ASA |
| Moderate Flare | 4 – 5 stools/day (or >=6 w/ 0 toxicity) | 0 systemic toxicity criteria | Oral Prednisolone / Outpatient Biologic |
| Acute Severe UC (ASUC) | >= 6 bloody stools/day | >= 1 marker (Temp>37.8, HR>90, Hgb<10.5, CRP>30) | Urgent Inpatient IV Steroids + Day-3 Check |
Truelove & Witts Systemic Toxicity Marker Count (0 to 4)
Counts how many of the four systemic toxicity thresholds are breached across Temperature B3 (°C), Heart Rate B4 (bpm), Hemoglobin B5 (g/dL), and CRP/ESR B6.
=IF(OR(B2 < 0, B3 < 32, B4 <= 20, B5 <= 2, B6 < 0), "Invalid Clinical Inputs", IF(B3 > 37.8, 1, 0) + IF(B4 > 90, 1, 0) + IF(B5 < 10.5, 1, 0) + IF(B6 > 30, 1, 0))Truelove & Witts Ulcerative Colitis Flare Classification (Mild / Moderate / ASUC)
Diagnoses Acute Severe UC when bloody stools B2 >= 6 AND at least 1 systemic toxicity marker is positive, Mild when stools < 4 with 0 markers, and Moderate otherwise.
=IF(OR(B2 < 0, B3 < 32, B4 <= 20, B5 <= 2, B6 < 0), "Invalid Clinical Inputs", IF(AND(B2 >= 6, (IF(B3 > 37.8, 1, 0) + IF(B4 > 90, 1, 0) + IF(B5 < 10.5, 1, 0) + IF(B6 > 30, 1, 0)) >= 1), "Acute Severe UC (ASUC — Urgent IV Steroids)", IF(AND(B2 < 4, (IF(B3 > 37.8, 1, 0) + IF(B4 > 90, 1, 0) + IF(B5 < 10.5, 1, 0) + IF(B6 > 30, 1, 0)) = 0), "Mild UC Flare", "Moderate UC Flare")))Try the example
Use the original values or change them to test your understanding.