The Travis Criteria (also frequently referred to as the Oxford Criteria) is a widely utilized clinical decision-making tool in gastroenterology. Developed by Dr. Simon Travis and colleagues in 1996, it is specifically designed to identify patients with Acute Severe Ulcerative Colitis (ASUC) who are at a high risk of failing intravenous (IV) corticosteroid therapy and subsequently requiring a colectomy.

While the Truelove and Witts criteria are used to diagnose the severity of a flare upon admission, the Travis Criteria are used 72 hours (Day 3) after starting intensive medical treatment to determine if a change in strategy is necessary.

1. The Day 3 Assessment

The Travis Criteria are remarkably simple, requiring only two clinical data points on the third day of IV steroid treatment.

The Criteria:

A patient is considered at high risk for medical failure if, on Day 3 of treatment, they meet either of the following conditions:

• Stool Frequency: > 8 bowel movements in a 24-hour period.
• Stool Frequency & Inflammation: 3 to 8 bowel movements in a 24-hour period AND a C-Reactive Protein (CRP) > 45 mg/L.

2. Predictive Power and Clinical Meaning

The original Oxford study demonstrated that patients meeting these criteria have an 85% probability of requiring a colectomy during that specific hospital admission if therapy is not escalated.

Why Day 3?

The 72-hour mark is considered the “window of opportunity.” Continuing ineffective steroid therapy beyond this point significantly increases the risk of surgical complications, such as bowel perforation or toxic megacolon, without increasing the likelihood of clinical remission.

• Positive Travis Result: Indicates “Steroid Refractoriness.” The medical team must immediately consider “rescue therapy” (e.g., Infliximab or Cyclosporine) or surgical consultation.
• Negative Travis Result: Suggests the patient is responding to steroids, and treatment can typically be continued while monitoring for further improvement.

3. Travis Criteria in the Modern Era

With the advent of advanced biologics (like Infliximab) and small molecules (like Tofacitinib), the rate of “in-hospital colectomy” for patients meeting the Travis Criteria has decreased from the original 85% to approximately 30–40% in some modern cohorts.

However, the criteria remain a powerful predictor of steroid non-response. Even if a colectomy is avoided during the initial stay via rescue therapy, a positive Travis score on Day 3 remains a marker for a more aggressive disease phenotype and a higher risk of future surgical intervention.

4. Comparison with the Ho Index

The Ho Index (or Scottish Index) is an alternative tool often compared to Travis. While Travis is a binary “high/low” risk tool, the Ho Index uses a 0–9 point scale (incorporating albumin levels and colonic dilatation).

• Travis: Preferred for its simplicity and bedside speed.
• Ho: Preferred for providing a more granular risk stratification (Low, Intermediate, and High risk).

5. References and Resources

Primary Reference

• Travis SP, et al. (1996). Predicting outcome in severe ulcerative colitis. Gut, 38(6), 905–910. View on PubMed

Clinical Validation & Comparisons

• Lynch RW, et al. (2016). Predicting outcome in acute severe ulcerative colitis: Comparison of the Travis and Ho scores using UK IBD audit data. Alimentary Pharmacology & Therapeutics, 43(11), 1132-1141. Read Article
• MDCalc – Travis Criteria Calculator: A digital tool for clinical use. Access Calculator

Guidelines

• ECCO Guidelines: European evidence-based consensus on the management of UC. ECCO Framework