What does the Truelove-Witts Index measure?

It classifies the severity of an ulcerative colitis flare as mild, moderate, or severe using daily stool frequency with blood, temperature, pulse, hemoglobin, and ESR. Severe disease requires at least 6 bloody stools per day plus at least one systemic sign (fever, tachycardia, anemia, or elevated ESR); mild disease meets all mild criteria; anything in between is moderate.

What hemoglobin unit should I use?

Enter hemoglobin in g/dL (grams per deciliter), which is the most common clinical unit. For example, a normal adult value is roughly 12–17 g/dL depending on sex.

What ESR unit should I use?

Enter ESR in mm/hr (millimeters per hour) as measured by the Westergren method. A value above 30 mm/hr is considered elevated in this index.

Is this tool a substitute for clinical judgment?

No. This tool is for educational and reference purposes only. All clinical decisions — including diagnosis, treatment, and hospitalization — must be made by a qualified healthcare professional considering the full clinical picture.

What are the original Truelove-Witts severe criteria?

Severe disease requires 6 or more bloody stools per day PLUS at least one of: fever above 37.8 °C (100 °F), pulse above 90 bpm, hemoglobin below 10.5 g/dL, or ESR above 30 mm/hr.

How does moderate disease differ from mild?

Mild disease has fewer than 4 bloody stools per day with no systemic disturbance and a normal ESR. Moderate disease falls between mild and severe — 4 to 6 bloody stools per day or borderline systemic signs.

Truelove-Witts Severity Index

Enter clinical parameters to classify ulcerative colitis as mild, moderate, or severe using the Truelove and Witts criteria.

Clinical Parameters

Enter values from the current flare episode.

Bloody stools per day

Temperature

Pulse rate (bpm)

Hemoglobin (g/dL)

ESR (mm/hr)

Enter clinical values and click Classify Severity to see the result.

Summary

The Truelove and Witts Severity Index, published in 1955, is a widely used clinical scoring system that categorizes ulcerative colitis (UC) flares into mild, moderate, or severe based on six objective parameters: daily stool frequency, presence of rectal bleeding, body temperature, pulse rate, hemoglobin level, and erythrocyte sedimentation rate (ESR). Clinicians use it to guide treatment decisions — mild disease may be managed with oral or topical aminosalicylates, while severe disease typically requires hospitalization and IV corticosteroids. This tool computes the classification instantly from the values you enter and explains the criteria applied.

How it works

Enter the number of bloody stools per day.
Record temperature, pulse rate, hemoglobin, and ESR.
The tool evaluates each parameter against the Truelove-Witts thresholds.
A classification of Mild, Moderate, or Severe is returned with the matching criteria highlighted.
Use the result alongside clinical judgment to guide treatment decisions.

Use cases

Quickly classify a UC flare severity at the bedside.
Document objective severity for clinical notes or referrals.
Decide whether hospitalization or IV therapy is warranted.
Track disease activity across follow-up visits.
Support clinical audit and quality improvement projects.
Teach medical students the Truelove-Witts classification system.

Frequently Asked Questions

Last updated: 2026-05-28 · Reviewed by Nham Vu