From the Guidelines
The Westley Croup Score is the most appropriate tool for assessing the severity of croup in children, guiding treatment decisions based on the score's categorization of mild, moderate, or severe croup. This scoring system evaluates five key parameters: level of consciousness, cyanosis, stridor, air entry, and retractions, with each parameter scored from 0-3, resulting in a total possible score of 17 1. The score is crucial for standardizing the assessment of croup severity and ensuring that treatment is appropriately tailored. For instance, a score of 0-2 indicates mild croup, which may be managed with observation and cool mist therapy, whereas a score of 3-5 suggests moderate croup, necessitating a single dose of oral dexamethasone (0.6 mg/kg, maximum 10 mg) 1.
Key Considerations for Croup Management
- The Westley Croup Score helps in categorizing croup into mild, moderate, and severe, which is essential for guiding treatment.
- For severe croup (score 6-17), the administration of dexamethasone plus nebulized epinephrine (3-5 mL of 1:1000 solution) is recommended, along with close monitoring for potential respiratory failure 1.
- Regular reassessment using the Westley Croup Score is vital for monitoring treatment response and determining the need for escalation of care.
- The use of a clinical guideline and orderset, as seen in a study published in Pediatrics in 2022 1, can significantly reduce hospital admissions for croup, highlighting the importance of standardized approaches in managing the condition.
Implementation and Outcomes
The implementation of a clinical guideline and orderset for croup management has been shown to reduce hospital admissions by 57% (95% CI: 24 to 89) 1, without significant changes in balancing measures such as inpatient airway interventions or length of stay (LOS). This underscores the effectiveness of standardized scoring and treatment protocols in improving outcomes for children with croup. The adoption of the Westley Croup Score as part of a standardized approach to croup management is recommended to improve patient outcomes and reduce unnecessary hospital admissions.
From the Research
Croup Scoring
- The Westley croup score is a commonly used assessment tool to evaluate the severity of croup in children 2.
- The score takes into account factors such as stridor, retractions, and air entry to determine the severity of the condition.
- A study found that the initial Westley score had a strong correlation with the length of hospital stay, with higher scores indicating a longer stay 2.
- The study also found that patients with an initial Westley score of 1-2 could be safely treated at home, while those with a score of 5 or higher required hospitalization for further treatment 2.
Assessment and Management
- The assessment of airway, breathing, and circulation is crucial in treating croup, with a focus on airway management 3.
- The use of steroids, such as prednisolone or dexamethasone, has been shown to reduce hospital admissions and improve outcomes for children with croup 4, 3, 5.
- Nebulized epinephrine may be added to the treatment regimen for patients with moderate to severe croup to improve symptoms and reduce length of hospitalization 4, 5.
- The decision to admit a child to the hospital is based on factors such as the severity of symptoms, the presence of stridor at rest, and evidence of exhaustion or respiratory distress 6, 2.