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Croup Scoring System

Purpose: To grade the severity of symptoms in children with croup.

Description

Children with croup can be assessed for severity of symptoms, which can be used to guide subsequent management. In the system of Westley et al, the range for each parameter is weighted to reflect the importance of the most severe finding. The score can be taken periodically during the day, and can be used to assess the effectiveness of different therapies.


Parameter

Finding

Points

level of consciousness

normal (including sleep)

0

 

disoriented

5

cyanosis

none

0

 

cyanosis on agitation

4

 

cyanosis at rest

5

stridor

none

0

 

stridor when agitated

1

 

stridor at rest

2

air entry

normal

0

 

decreased

1

 

markedly decreased

2

retractions

none

0

 

mild

1

 

moderate

2

 

severe

3

 

croup score =

= (points for consciousness) + (points for cyanosis) + (points for stridor) + (points for air entry) + (points for retractions)

 

Need for clarification:

(1) For the  level of consciousness, the score to give when mildly affected is unclear.

 

Modification of Klassen et al: Stridor is assessed with a stethoscope at rest.

(1) If audible at rest without a stethoscope, then 2 points are assigned.

(2) If audible at rest only with a stethoscope, then 1 point is assigned.

 

Interpretation:

• minimum score: 0

• maximum score: 17

• Persistent stridor at rest after 15-30 minutes observation is associated with risk for rapid progression to respiratory obstruction.


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Specialty

Objective

ICD-10