Truelove and Witts severity index for Ulcerative Colitis
The Truelove and Witts Severity Index is a clinical tool used to categorize the severity of ulcerative colitis (UC), a type of inflammatory bowel disease. Established in 1955 by Truelove and Witts, the index helps determine the course of treatment by classifying the disease into mild, moderate, or severe categories based on key clinical parameters. These parameters include the number of bowel movements per day, the presence of blood in stools, fever, tachycardia, hemoglobin levels, and erythrocyte sedimentation rate (ESR). This index is widely used in both clinical practice and research to guide management decisions and assess the effectiveness of therapeutic interventions.
| – | Mild | Moderate | Severe |
| Bowel movements (number per day) | Fewer than 4 | 4–6 | 6 or more plus at least 1 of the features of systemic upset (marked with * below) |
| Blood in stools | No more than small amounts of blood | Between mild and severe | Visible blood |
| Fever | No | No | Yes |
| Pulse rate greater than 90 bpm * | No | No | Yes |
| Anaemia * | No | No | Yes |
| Erythrocyte sedimentation rate (mm/hour) * | 30 or below | 30 or below | Above 30 |
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References
- Truelove, S. C., & Witts, L. J. (1955). Cortisone in ulcerative colitis: final report on a therapeutic trial. British Medical Journal, 2(4947), 1041-1048.
- This is the original study that introduced the Truelove and Witts Severity Index, establishing a framework for the classification of ulcerative colitis severity.
- Dignass, A., Lindsay, J. O., Sturm, A., Windsor, A., Colombel, J. F., Allez, M., … & Travis, S. P. (2012). Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. Journal of Crohn’s and Colitis, 6(10), 991-1030.
- This consensus paper discusses the application of various clinical indices, including the Truelove and Witts Severity Index, in the management of ulcerative colitis.
- Harbord, M., Eliakim, R., Bettenworth, D., Karmiris, K., Katsanos, K., Kopylov, U., … & European Crohn’s and Colitis Organisation [ECCO]. (2017). Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. Journal of Crohn’s and Colitis, 11(7), 769-784.
- This document provides updated guidelines on the management of ulcerative colitis, referencing tools like the Truelove and Witts Severity Index for assessing disease activity.