Clinical Croup Score

Children with croup can be triaged rapidly and easily by a simple scoring system.

Parameters:

(1) inspiratory breath sounds

(2) stridor

(3) cough

(4) retractions and nasal flaring

(5) cyanosis

Parameter	Finding	Score
inspiratory breath sounds	normal	0
	harsh, with rhonchi	1
	delayed	2
stridor	none	0
	inspiratory	1
	inspiratory and expiratory	2
cough	none	0
	hoarse cry	1
	bark	2
retractions and nasal flaring	none	0
	nasal flaring and suprasternal retractions	1
	nasal flaring; suprasternal, subcostal, and intercostal retractions	2
cyanosis	none	0
	present in room air (FIO2 0.21)	1
	present in 40% oxygen (FIO2 0.40)	2

Modified Score (Waisman, 1992)

This is the same as above, except assessment of cyanosis is replaced by oxygen saturation.

Parameter	Finding	Score
oxygen saturation	>= 95% on room air	0
	< 95% in room air (FIO2 0.21) but >=95% in 40% oxygen (FIO2 0.40)	1
	<95% in 40% oxygen (FIO2 0.40)	2

Interpretation:

• maximum score 10

• minimum score 0

• scores of 0-3: minimal risk

• scores of 4-6: moderate risk; child may benefit from inhalation treatment

• scores 7-10: high risk; intubation may be necessary and a tracheostomy tray should be readily available if not intubated

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