clinical based scales to assess severity of ulcerative colitis (UC)
Last reviewed 01/2018
Severity of ulcerative colitis
The severity of ulcerative colitis can be classified as mild, moderate and severe
In adults these categories are based on the Truelove and Witts' severity index
| Mild | Moderate | Severe | |
| Bowel movements (no. per day) | Fewer than 4 | 4-6 | 6 or more plus at least one 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 |
| Pyrexia (temperature greater than 37.8°C) * | no | no | yes |
| Pulse rate greater than 90 bpm * | no | no | yes |
| Anaemia (< 10g/100mL)* | no | no | yes |
| Erythrocyte sedimentation rate (mm/hour) * | 30 or below | 30 or below | above 30 |
In children and young people these categories are based on the Paediatric Ulcerative Colitis Activity Index (PUCAI)
Paediatric Ulcerative Colitis Activity Index (PUCAI)
Disease severity is defined by the following scores:
- severe: 65 or above
- moderate: 35-64
- mild: 10-34
- remission (disease not active): below 10
| Item | Category/Points |
| Abdominal pain |
No pain = 0 Pain can be ignored = 5 Pain cannot be ignored = 10 |
| Rectal bleeding |
None = 0 Small amount only, in less than 50% of stools = 10 Small amount with most stools =20 Large amount (50% of the stool content) = 30 |
| Stool consistency of most stools |
Formed = 0 Partially formed = 5 Completely unformed = 10 |
| Number of stools per 24 hours |
0-2 = 0 points 3-5 = 5 points 6-8 = 10 points >8 = 15 points |
| Nocturnal stools (any episode causing wakening) |
no = 0 points yes = 10 points |
| Activity Level |
No limitation of activity = 0 Occasional limitation of activity = 5 Severe restricted activity = 10 |
| Sum of PUCAI (0-85) |
Be aware that there may be an increased likelihood of needing surgery for people with any of the following:
- stool frequency more than 8 per day
- pyrexia
- tachycardia
- an abdominal X-ray showing colonic dilatation
- low albumin, low haemoglobin, high platelet count or C-reactive protein (CRP) above 45 mg/litre (bear in mind that normal values may be different in pregnant women)
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