Colitis: clinical findings helped predict patients who failed to improve on medical therapy.

Clinical bottom line (level 2b)

Around a quarter of patients admitted with acute proctocolitis failed to improve on medical therapy.
Patients with low albumin, high pulse rate or temperature and high stool frequency on admission were at increased risk of not responding to medical therapy.

Lennard-Jones et al: Gut 1975; 16: 579-584

Expires May 2003

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospital, UK

166 patients (aged ?, ?% male) with 189 episodes of acute proctocolitis

Excluded if

admitted for investigation, assessment or elective surgery

Factors studied:

medical therapy failure

Linear stepwise discriminant analysis was performed on the risk factors.

?0100% followed for until discharge
Outcomes studied:

failure of medical therapy or immediate surgery required

The evidence

outcome	time to outcome	number of patients/total number	% (95% CI)	NNF (95% CI)
failure of medical therapy or immediate surgery required	until discharge	45/189	24% (18% to 30%)	4 (3 to 6)

best combination of risk factors:
- maximum temperature or pulse rate (90 or more) on any day
- observed bowel frequency on day of admission (6 or more)
- serum albumin level (35 or less)

Comments

No data was given to support the conclusions.
This clinical prediction rule needs to be prospectively validated.

Citation

Lennard-Jones JE, Ritchie JK, Hilder W, et al: assessment of severity in colitis: a preliminary study. Gut 1975; 16: 579-584

Search Terms: reference from review article
Contributor: Chris Ball and Clare Wotton, November 2000
Reviewer:

_{Clinical Question.}

_Patient	_{acute proctocolitis}
_{Intervention or Exposure}	_{risk factors}
_Outcome	_{non-response to medical therapy}