The Westley Croup Score is the primary diagnostic rubric used in pediatric emergency medicine to determine the appropriate treatment for a child presenting with a barking cough and stridor.
The Danger of Airway Swelling
Because children have very narrow airways, even a few millimeters of viral swelling can cause a massive obstruction to airflow. The Westley score quantifies how much that swelling is affecting the child's ability to breathe.
Treatment Pathways
The score directly dictates the pharmacological intervention:
- Mild Croup (Score ≤ 2): The child may have a barking cough but is breathing comfortably at rest. Treatment involves a single dose of oral steroids (Dexamethasone) and discharge home.
- Moderate Croup (Score 3-7): The child has stridor at rest and visible chest retractions. Treatment requires oral steroids and usually a nebulized breathing treatment of Epinephrine, which rapidly constricts the blood vessels in the airway, shrinking the swelling.
- Severe Croup (Score ≥ 8): The child is struggling to breathe, anxious, or cyanotic (blue). This requires immediate nebulized epinephrine, IV steroids, and potential admission to the Pediatric ICU.
Sum of points for Stridor, Retractions, Air Entry, Cyanosis, and Level of Consciousness.