Westley Croup Score Calculator

How does this Westley croup score calculator work?

This is a health tool aimed to measure severity of croup that is often used to as well prognosticate this respiratory diseases that affects mostly children under the age of 12 and as little as 3 months.

The Westley model is used in research settings and in different studies such as those assessing post extubation upper airway obstruction.

This Westley croup score calculator comprises of five criteria, each of them with answer choices. It evaluates the general state of consciousness of the patient, cyanosis signs, airway obstructions, chest wall retractions and inspiratory stridor.

As the five questions are answered, the result comprises of the score itself and the degree of severity it belongs to.

Originally, the score belonged to a research study about the clinical response of nebulized racemic epinephrine vs saline dating from 1978 and the mild, moderate, severe interpretation appeared several years later.

Westley Croup Score Interpretation

Mild [0 – 2 points]

■ Occasional barking cough;

■ No or mild suprasternal and/or intercostal retractions;

■ No or limited stridor at rest.

Moderate [3 – 5 points]        

■ Little distress or agitation;

■ Frequent barking cough;

■ Suprasternal and sternal wall retraction at rest;

■ Easily audible stridor at rest.

Severe [ 6 – 11 points]

■ Significant distress and agitation;

■ Present barking cough;

■ Marked sternal wall retractions;

■ Prominent inspiratory and expiratory stridor.

Extremely severe - Impending respiratory failure [12 – 17 points]

■ Lethargy or decreased level of consciousness;

■ Frequent cases with dusky complexion without supplemental oxygen;

■ Barking cough (frequently non prominent);

■ Sternal wall retractions (may or may not be present);

■ Audible stridor while at rest (sometimes hard to hear).

What is croup? Medical implications.

Croup of acute tracheolaryngobronchitis is a common respiratory disease, often (75%) caused by the Human Parainfluenza virus, a well known respiratory pathogen. It is said to affect children (extremely rare occurrence in adults) with 3% of children before age 6 acquiring it every year. However, only less than 5% of the cases require hospitalization as the symptoms can often be treated ambulatory.

Some clinicians make a difference between 2 subtypes: acute laryngotracheitis and spasmodic croup. In the first case, the patients usually have a history of upper respiratory tract infections, are febrile and their symptoms persist longer. In the case of spasmodic croup, patients are usually afebrile and experience more transient symptoms.

Most common signs install abruptly: barking cough, inspiratory stridor, hoarseness and general respiratory distress due to upper airway obstruction. In most cases the symptoms presented are of mild intensity, last only a few days (usually resolve in 48 hours) and worsen at night.

If left untreated, croup can lead to hypoxia and hypercapnia which in turn lead to respiratory failure and arrest.

Treatment methods aim to minimize the duration and severity of symptoms and include humidified air therapy, racemic epinephrine or glucocorticoid medication.

References

1) Westley CR, Cotton EK, Brooks JG. (1978) Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child; 132(5):484-7.

2) Bjornson CL, Johnson DW. (2005) Croup-treatment update. Pediatr Emerg Care; 21(12):863-70