Westley croup severity score

Clinical feature			Assigned score
Level of consciousness
Normal, including sleep			0
Disoriented			5
Cyanosis
None			0
With agitation			4
At rest			5
Stridor
None			0
With agitation			1
At rest			2
Air entry
Normal			0
Decreased			1
Markedly decreased			2
Retractions
None			0
Mild			1
Moderate			2
Severe			3
Total
Score total	Severity	Description	Management
≤2	Mild	Occasional barky cough, no stridor at rest, mild or no retractions	Home management – Symptomatic care including antipyretics and oral fluids Patients seen in clinic or in the ED – Single dose of oral dexamethasone^* 0.15 to 0.6 mg/kg (maximum 16 mg) or oral prednisolone (1 mg/kg)
3 to 7	Moderate	Frequent barky cough, stridor at rest, mild to moderate retractions	Single dose of oral dexamethasone 0.6 mg/kg (maximum 16 mg)^* Nebulized epinephrine^¶ Hospitalization is generally not needed but may be warranted for persistent or worsening symptoms after treatment with glucocorticoid and nebulized epinephrine
8 to 11	Severe	Frequent barky cough, stridor at rest, marked retractions, significant distress	Single dose of oral/IM/IV dexamethasone 0.6 mg/kg (maximum 16 mg)^* Repeated doses of nebulized epinephrine^¶ may be needed Inpatient admission is generally required unless marked improvement occurs after treatment with glucocorticoid and nebulized epinephrine
≥12	Impending respiratory failure	Depressed level of consciousness, stridor at rest, severe retractions, poor air entry, cyanosis or pallor	Single dose of IM/IV dexamethasone 0.6 mg/kg (maximum 16 mg) Repeated doses of nebulized epinephrine^¶ may be needed Intensive care unit admission is generally required Consultation with anesthesiologist or ENT surgeon may be warranted to arrange for intubation in a controlled setting

ED: Emergency department; ENT: ear, nose, throat; IM: intramuscular; IV: intravenous.

* When administering oral dexamethasone, we either crush an oral tablet and mix it with pureed food, or we use the IV solution and administer it orally (as-is or mixed with flavored syrup). This is because the available oral dexamethasone preparations have several limitations, including unpleasant taste, high ethanol content, and lower drug concentration compared with the IV solution (meaning that the child must swallow a larger volume of medication for a given dose).

¶ Dosing and administration are as follows:

Racemic epinephrine: 0.05 mL/kg per dose (maximum of 0.5 mL) of a 2.25% solution diluted to 3 mL total volume with normal saline (in the United States and some other countries, single-use preservative-free bullets [ampules] of racemic epinephrine for nebulized administration are commercially available).
L-epinephrine: 0.5 mL/kg per dose (maximum of 5 mL) of a 1 mg/mL preservative-free solution (this is the parenteral preparation of epinephrine used for IM injection [eg, for anaphylaxis]).

Administer by nebulizer over 5 to 15 minutes. Use of either product is acceptable and may be determined by availability and institutional protocol. Nebulized epinephrine has an onset of effect within 10 minutes. Refer to UpToDate topic on management of croup for additional details.

Graphic 100744 Version 10.0

خرید پکیج

Westley croup severity score