Croup Diagnosis

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	1
	Moderate	2
	Severe	3

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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