Criteria
Clinical classification of severity[19]
Mild: seal-like barky cough but no stridor or sternal/intercostal retractions at rest
Moderate: seal-like barky cough with stridor and sternal retractions at rest; no agitation or lethargy
Severe: seal-like barky cough with stridor and sternal/intercostal retractions associated with agitation or lethargy
Impending respiratory failure: increasing upper airway obstruction, sternal/intercostal retractions, asynchronous chest wall and abdominal movement, fatigue, and signs of hypoxia (pallor or cyanosis) and hypercapnia (decreased level of consciousness secondary to rising PaCO₂). The degree of chest wall retractions may diminish with the onset of respiratory failure as the child tires.
StridorAuscultation sounds: Stridor
Westley croup score: research classification
Total score ranging from 0 to 17 points. Five component items make up the score:[37]
Stridor (0 = none, 1 = with agitation only, 2 = at rest)
Retractions (0 = none, 1 = mild, 2 = moderate, 3 = severe)
Cyanosis (0 = none, 4 = cyanosis with agitation, 5 = cyanosis at rest)
Level of consciousness (0 = normal - including asleep, 5 = disoriented)
Air entry (0 = normal, 1 = decreased, 2 = markedly decreased).
The Westley croup score has been used in numerous clinical research studies to classify croup into mild, moderate, and severe categories. A total score ≤1 is typically considered mild, 2 to 4 is considered moderate, and a score ≥5 is considered severe.[38] However, substantial interobserver variability exists when the score is used in clinical practice, thus limiting its use in the clinical setting.[39]
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