Croup-Westley score

Epidemiology

Croup is the most common pediatric illness that causes acute stridor, accounting for approximately 15% of clinic and emergency department visits for pediatric respiratory tract infections. It is primarily a disease of infants and toddlers, with a peak incidence from age 6 months to 36 months (3 years). In North America, incidence peaks in the second year of life, at 5-6 cases per 100 children. Although the disease is rare after age 6 years, it may be seen as late as ages 12-15 years.

The male-to-female ratio for croup is approximately 1.4:1. The disease is most common in late fall and early winter but may be seen at any time of year. Approximately 5% of children experience more than 1 episode.

Westley score

Croup scores have been developed to assist the clinician in assessing the degree of respiratory compromise. One of the most commonly cited is the Westley score. Although widely used to evaluate treatment protocols, its clinical efficacy has not been extensively studied. The score evaluates the severity of croup by assessing the following 5 factors, with a score range of 0 to 17:

• Inspiratory stridor: None - 0 points, Upon agitation - 1 point, At rest - 2 points
• Retractions: None - 0 points, Mild - 1 point, Moderate - 2 points, Severe - 3 points
• Air entry: Normal - 0 points, Mild decrease - 1 point, Marked decrease - 2 points
• Cyanosis: None - 0 points, Upon agitation - 4 points, At rest - 5 points
• Level of consciousness: Normal, including sleep - 0 points, Depressed - 5 points

According to the Westley score, a score of less than 3 represents mild disease; a score of 3-6 represents moderate disease; and a score greater than 6 represents severe disease.(Source: Emedicine )

Severity

The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice.^[2] It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions.^[2] The points given for each factor is listed in the table to the right, and the final score ranges from 0 to 17.^[6]

• A total score of ≤ 2 indicates mild croup. The characteristic barking cough and hoarseness may be present, but there is no stridor at rest.^[5]
• A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs.^[5]
• A total score of 6–11 is severe croup. It also presents with obvious stridor, but also features marked chest wall indrawing.^[5]
• A total score of ≥ 12 indicates impending respiratory failure. The barking cough and stridor may no longer be prominent at this stage.^[5]

85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%).^{[5] (Source:Wikipedia)}