Truelove and Witts Score

The Truelove and Witts Score: Evaluating Ulcerative Colitis

The Truelove and Witts Score was created in 1955. It is the first historical classification and remains the clinical standard today for evaluating the severity of an Ulcerative Colitis (UC) flare. It quickly identifies patients requiring urgent hospitalization.

How is severity determined?

Unlike other scores that add points, Truelove and Witts works by validating criteria:

• Severe Flare (Acute Severe Colitis): Defined by the presence of ≥ 6 bloody stools per day, associated with at least one sign of systemic toxicity (Temp > 37.8°C, HR > 90 bpm, Hb < 10.5 g/dL, or ESR > 30 mm/h).
• Mild Flare: Fewer than 4 stools per day, intermittent blood, no signs of systemic toxicity, and normal ESR.
• Moderate Flare: Any patient who falls between the criteria for the mild form and the severe form.

Summary of Severity Criteria

Parameter	Mild	Severe
Selles / jour	< 4	≥ 6
Sang dans les selles	Intermittent	Fréquent
Température (°C)	Normale	> 37.8
Pouls (bpm)	Normal	> 90
Hémoglobine (g/dL)	> 11.0	< 10.5
VS (mm/h)	< 30	> 30

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References:

1. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041-8. [NIH - PubMed]
2. Dignass A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 1: Definitions and diagnosis. J Crohns Colitis. 2012. [ECCO Guidelines]