croup
CROUP
Croup is a viral infection that causes erythema and edema of the tracheal walls and narrowing of the subglottic region. It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children and requiring immediate treatment.
Most common causes are parainfluenza virus 1&2 and respiratory syncytial virus.
Occurrence of symptoms is usually at night and with abrupt onset and improve during daytime.

Diagnosis

Croup in children is a medical emergency requiring immediate treatment
Severity of Airway Obstruction
Westley Croup Score
  • The most commonly used scoring system for the management of croup
  • Scoring is based on patient’s symptoms from which total score is obtained to categorize the severity
 Symptom  Status Score 
 Consciousness  Normal, including sleep 0
   Disoriented 5
 Cyanosis  None 0
   With agitation 4
   At rest 5
 Stridor  None 0
   With agitation 1
   At rest 2
 Air entry  Normal 0
   Decreased 1
   Markedly decreased 2
 Chest wall retractions  None 0
   Mild
   Moderate
   Severe

Total Score   Severity
 ≤2 Mild 
3-7 Moderate 
8-11  Severe
 ≥12 Impending respiratory failure 

Mild
  • Occasional barking cough
  • Patient is comfortable, no cyanosis
  • Intermittent stridor may or may not be observed
  • Chest wall retractions minimal or none at all
Moderate
  • Frequent barking cough
  • Stridor persistent even at rest
  • Chest wall retractions at rest are observed, tracheal tug & nasal flaring present 
  • Tachycardia, labored breathing, increased respiratory rate
  • Irritable, little or no distress
  • Symptoms may progress to severe airway obstruction, careful observation is warranted
Severe
  • Frequent barking cough
  • Patient appears tired, easily irritated, lethargic and exhausted, restless & agitated
  • Persistent tachycardia
  • Prominent stridor even at rest (inspiratory with or without expiratory stridor)
  • Marked chest wall retractions, tracheal tug and nasal flaring present, markedly increased/decreased respiratory rate 

 Impending Respiratory Failure

  • Barking cough (may not be prominent)
  • Audible stridor at rest
  • Chest wall retractions
  • Irrational behavior, decreased level of consciousness
  • Hypotonia
  • Pallor, cyanosis without supplemental oxygen (O2)

Laboratory Tests

Pulse Oximetry
  • Determines oxygen saturation
  • Clinical assessment is more important than oximetry results
    • Patient with symptoms of severe respiratory obstruction may present with nearly normal oxygen saturation on oximetry


Imaging Studies

  • Not routinely used but may be considered
  • In chest radiography, steeple sign is most often manifested in patients with croup
  • Computed tomography and laryngoscopy may be considered to rule out other diseases
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 13 Jan 2020
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
Stephen Padilla, 6 days ago
The Lancet Commission on Hypertension Group has recently released a position statement that contains a list of recommendations for the improvement of accuracy standards for devices that measure blood pressure (BP).