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Truelove & Witts Severity Calculator

Enter stool frequency, bleeding, vitals and labs to score severity.

How it is calculated

The tool counts how many of six criteria are met, each with a strict cut-off: stools per day ≥ 6, blood in the stool (yes), temperature > 37.8 °C, pulse > 90 beats per minute, haemoglobin < 10.5 g/dL and ESR > 30 mm/h. Values exactly on the limit (37.8 °C, a pulse of 90, 10.5 g/dL, ESR 30) do not count.

The grade follows Truelove and Witts: Severe is 6 or more bloody stools a day plus at least one of the four signs (temperature, pulse, haemoglobin, ESR); Mild is fewer than 4 stools a day and none of those signs; everything between is Moderate. A one-line note and the count of criteria met, for example 2 of 6, are shown beside it. All six fields are required, blood is a yes (1) or no (0) choice, and the temperature must be in degrees Celsius. This is a simple rule for information, not a diagnosis; the actual grading and any treatment decision belong to a clinician.

Worked example

A patient has 7 stools a day, visible blood, temperature 37.2 °C, pulse 88, haemoglobin 11.8 g/dL and ESR 24 mm/h. Stools: 7 ≥ 6, met. Blood: yes, met. Temperature: 37.2 is not above 37.8, not met. Pulse: 88 is not above 90, not met. Haemoglobin: 11.8 is not below 10.5, not met. ESR: 24 is not above 30, not met. Result: 2 of 6 criteria, which the tool grades as Moderate.

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Common mistakes

  • Entering temperature in Fahrenheit. A normal 98.6 would be read as 98.6 °C and always count as fever; use degrees Celsius.
  • Entering haemoglobin in g/L (for example 118) instead of g/dL (11.8). The value then never falls below 10.5, so the anaemia criterion is never counted.
  • Entering the stool count of a single day that is not typical, or counting only bloody stools. The field is total stools per day, and blood is a separate yes/no field.
  • Expecting a Severe grade from the stool and blood findings alone. Severe also needs at least one of the four signs; without one, even many bloody stools stay Moderate.
  • Treating the result as a diagnosis or a reason to delay care. A score of 0 of 6 is shown as Mild but does not exclude active disease.

Sources

About this calculator

The Truelove & Witts index, published in 1955, was the first standardized way to grade ulcerative colitis severity and is still the basis for the “mild/moderate/severe” categories used in clinical practice today. It classifies severity from six criteria: stool frequency, visible blood in stool, fever, heart rate, hemoglobin (anemia), and ESR (erythrocyte sedimentation rate, a marker of inflammation).

This tool counts how many of the six “severe” thresholds are met — 6 or more stools a day, visible blood, temperature above 37.8 °C, pulse above 90, hemoglobin below 10.5 g/dL, ESR above 30: none met is graded mild, one to five met is moderate, and all six met is severe.

Gastroenterologists use severity grading like this to decide whether a flare can be managed as an outpatient or needs hospital admission for IV steroids, and it remains a reference point that later scores (like the Mayo score) were built to refine. This tool is for reference only, not medical advice.

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Comments (1)

  • Editorial team

    This page counts six yes-or-no criteria at one moment, so enter values measured around the same time, not a mix from different days. Severe appears only when all six are met, which means five of six still reads Moderate, so a high count deserves attention whatever the label says. It is a counting aid for students and carers, not a diagnosis. Clinicians and students: would you like the individual criteria listed beside the grade?

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