P0387 Predicting Early Recognition of Acute Severe Ulcerative Colitis based on Presence of Truelove and Witts’ Systemic Features at Time of Presentation
Authors: Nario S , Wu M Y , Tung C , Kiely C 
Published: January 2025

Abstract

Background
Acute severe ulcerative colitis (ASUC) is a medical emergency. Early recognition and diagnosis are necessary to initiate timely and appropriate investigations and treatment. The Truelove and Witts’ criteria (TWC) is used to stratify severity of Ulcerative Colitis (UC) and thus identify those presenting with ASUC. However, TWC is underutilised in the emergency department, leading to delayed diagnosis.1 We aimed to assess which TWC features are present at time of ASUC presentation. We hypothesised that an increase in number of systemic features present may be associated with an increase in early recognition and diagnosis of ASUC.

Methods
A retrospective review was conducted on all patients presenting to a quaternary Sydney hospital over a 10-year period (January 2014 to May 2024) with “Ulcerative Colitis”, as coded by ICD diagnosis. Each admission coded with UC was reviewed and those meeting criteria as ASUC on presentation were included for further analysis. Using a modified TWC, we defined ASUC as ≥6 bloody bowel motions daily and presence of at least one systemic feature, including heart rate (HR) &gt;90 bpm, temperature &gt;37.8°C, haemoglobin (Hb) &lt;105 g/L, and C-reactive protein ≥30.2

Results
During the study period, there were a total of 617 presentations to hospital with UC and 172 that met criteria for ASUC. Only 30.2% of all presentations were recognised, as defined by documentation of “ASUC” by clinicians within 24 hours of presentation. In patients presenting with ASUC, mean HR was 101.7 bpm, temperature 37.2°C, Hb 126.0 g/L and CRP was 71.1mg/L. We found no significant difference in early diagnosis of ASUC between patients who presented with one systemic feature compared to those who presented with more than one systemic feature (33.8% vs. 27.9%, p = 0.41). HR &gt;90 bpm was the most common systemic feature at time of presentation; it was the only systemic feature present in 38 presentations, with 34.2% of these recognised and documented as ASUC within 24 hours, which was not significantly increased compared with only one of the other systemic features (34.2% vs. 29.1%, p = 0.545). Time to commence steroids if ASUC was recognised within 24 hours was 0.16 (± 0.26) days, compared to 0.73 (± 2.5) days if ASUC was recognised &gt;24 hours (p &lt;0.05).

Conclusion
Less than one third of patients that met ASUC criteria were diagnosed as such within 24 hours of presentation. Tachycardia and elevated CRP were the most frequent systemic features present met for diagnosis of ASUC at time of presentation. Clinicians should be more familiar with identifying systemic features of severity, as defined by TWC, in order to recognise patients with ASUC at time of presentation. Delays to diagnosis of ASUC may impact on patient treatment and outcomes.

References
1. Chhaya V, Squire Y, Siva N, Poullis A. PWE-261 Have you heard of the Truelove and Witts criteria? acute severe ulcerative colitis management by FY1 doctors. Gut. 2012;61(Suppl 2):A404-A404. doi:10.1136/GUTJNL-2012-302514D.261
2. Sturm A, Maaser C, Calabrese E, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis. 2019;13(3):273-284. doi:10.1093/ECCO-JCC/JJY114