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
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