Croup

Question 1

What is croup?

Answer 1

Croup is a common viral inflammatory illness causing the narrowing of the subglottic airway. It is characterised by a ‘seal like’ barking cough, inspiratory stridor and hoarseness of voice (with or without respiratory distress).

Commonly occurs at night between 2100 & 0600 .

Most common in patients under 5 years.

Question 2

What are the clinical features of croup?

Answer 2

• A ‘seal like’ barking cough, inspiratory stridor and hoarseness of voice (with or without respiratory distress)
• Symptoms are usually mild to moderate
• Duration usually 2-5 days with symptoms worse at night (often peaking on night 2 or 3)

Question 3

What are the differential diagnoses of acute stridor & respiratory distress?

Answer 3

1. Foreign body inhalation
2. Retropharyngeal or peritonsillar abscess
3. Bacterial tracheitis
4. Epiglottitis

Question 4

What is the Westley Croup Score (WCS)?

Answer 4

The WCS is a validated and frequently used croup severity assessment tool based on clinical signs & symptoms.

Scored from 0-17.
<2 = mild
3-7 = moderate
>8 = severe

The five categories used to assess are:

1. Level of consciousness
   - Disorientated (5)
   - Normal, including sleep (0)
2. Cyanosis
   - At rest (5)
   - With agitation (4)
   - None (0)
3. Stridor
   - At rest (2)
   - With agitation (1)
   - None (0)
4. Air Entry
   - Markedly decreased (2)
   - Decreased (1)
   - Normal (0)
5. Chest Wall Retractions
   - Severe (3)
   - Moderate (2)
   - Mild (1)
   - None (0)

Question 5

Outline the treatment strategies for each severity of croup.

Answer 5

Mild Croup (WCS 2 or less)

• Dexamethasone (0.3mg/kg) PO
• Reassess & document WCS every 15 min.

Moderate Croup (WCS 3-7)

• Adrenaline NEB (5mg) single dose
• Dexamethasone
• Reassess & document WCS every 15 min.

Severe Croup (WCS 8+)

• Adrenaline NEB (5mg) single dose
• Dexamethasone
• Reassess & document WCS every 15 min.

ALL patients with suspected croup are to be transported to hospital for assessment.