2/9/2017 Calculator: Westley croup severity score - UpToDate

Level of consciousness
Normal, including sleep (0 points)
Disoriented (5 points)
Cyanosis
None (0 points)
With agitation (4 points)
At rest (5 points)
Stridor
None (0 points)
With agitation (1 point)
At rest (2 points)
Air entry
Normal (0 points)
Decreased (1 point)
Markedly decreased (2 points)
Retractions
None (0 points)
Mild (1 point)
Moderate (2 points)
Severe (3 points)

Total criteria point count: 0

Reset form

Westley croup severity score interpretation

Score Severity Description Management

Home treatment: Symptomatic care including antipyretics,

mist, and oral fluids
Occasional barky cough, no stridor at
0 to 2 Mild
rest, mild or no retractions Outpatient treatment: Single dose of oral dexamethasone 0.6
mg/kg (maximum 10 mg)*

Single dose of oral dexamethasone 0.6 mg/kg (maximum 10

mg)*

Frequent barky cough, stridor at rest,

3 to 7 Moderate and mild-to-moderate retractions, but Nebulized epinephrine**
no or little distress or agitation
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, Single dose of oral/IM/IV dexamethasone 0.6 mg/kg
marked retractions, significant distress (maximum 10 mg)*
and agitation

Repeated doses of nebulized epinephrine** may be needed

https://www.uptodate.com/contents/calculator-westley-croup-severity-score 1/2
2/9/2017 Calculator: Westley croup severity score - UpToDate

Inpatient admission is generally required unless marked

improvement occurs after treatment with glucocorticoid and
nebulized epinephrine

Single dose of IM/IV dexamethasone 0.6 mg/kg (maximum

10 mg)*

Impending Depressed level of consciousness, Repeated doses of nebulized epinephrine** may be needed
12 to 17 respiratory stridor at rest, severe retractions, poor
failure air entry, cyanosis or pallor Intensive care unit admission is generally required

Consultation with anesthesiologist or ENT surgeon may be

warranted to arrange for intubation in a controlled setting

Notes

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

*The intravenous preparation of dexamethasone (4 mg per mL) can be given orally; mix with flavored syrup.

**Nebulized epinephrine has an onset of effect within 10 minutes. Nebulized racemic epinephrine is administered as
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.
Racemic epinephrine is commercially available in the United States and some other countries as a nebulizer
preparation (ie, single-use preservative-free bullets [ampules]). Nebulized L-epinephrine is administered as 0.5 mL/kg
per dose (maximum of 5 mL) of a 1 mg/mL (1:1000) preservative-free solution. L-epinephrine is the same type of
epinephrine used in other medical indications (eg, IM injection for anaphylaxis) and is widely available as a parenteral
preparation. Use of either product by nebulization is acceptable and may be determined by availability and institutional
protocol.

Refer to the UpToDate topic for detail.

References

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

Use of UpToDate is subject to the Subscription and License Agreement.

Only digits 0 to 9 and a single decimal point (".") are acceptable as numeric inputs. Attempted input of other characters into a numeric field
may lead to an incorrect result.

Information on this page may not appear correctly if printed.

Legal Notices and Disclaimer

All information contained in and produced by the EBMcalc system is provided for educational purposes only. This information should not be used for
the diagnosis or treatment of any health problem or disease. THIS INFORMATION IS NOT INTENDED TO REPLACE CLINICAL JUDGMENT OR
GUIDE INDIVIDUAL PATIENT CARE IN ANY MANNER. Click here for full notice and disclaimer.

EBMcalc is Copyright © 1998-2017 Foundation Internet Services, LLC

Topic 105432 Version 2.0

https://www.uptodate.com/contents/calculator-westley-croup-severity-score 2/2