Recommendation ID
CG166/5
Question
Risk tool for predicting the likelihood of needing surgery for adults with acute severe ulcerative colitis:- To develop and validate a risk tool that predicts the likelihood of needing surgery for adults admitted to hospital with acute severe ulcerative colitis.
Any explanatory notes
(if applicable)
Why this is important:- Acute severe ulcerative colitis is a life-threatening emergency. About 30% of people admitted to hospital with acute severe ulcerative colitis will require colectomy to avoid colonic perforation during the emergency admission. The Truelove and Witts' severity index is used to define the clinical severity of disease on admission but has not been validated as a predictor of the need for colectomy during treatment. The Travis (Oxford) criteria are used to predict the likelihood of colectomy after 3 days of treatment with intravenous steroids, but may be less useful later in the course. No tools have been developed and validated in patients receiving rescue therapy with anti-tumour necrosis factor (TNF) antibodies or ciclosporin. A validated tool that can reliably predict a person's likelihood of needing a colectomy over the course of an admission to hospital for treating acute severe ulcerative colitis would allow the medical and surgical teams and the person to prepare for colectomy and potentially inform decisions about introducing rescue therapy with ciclosporin or infliximab and when continued medical therapy is unlikely to be successful. There may also be psychological and nutritional benefits to the person and cost benefits to the NHS (for example, shorter length of inpatient stay; decreased risk of infection; less use of rescue therapy). The tool would be developed by a derivation study using a prospective cohort. The tool would be validated using a different prospective cohort from that of the derivation study.

Source guidance details

Comes from guidance
Ulcerative colitis: management
Number
CG166
Date issued
June 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 15/07/2013