Croup

Background

• Croup = laryngotracheobronchitis
• Affects 6 mo-3 yr (peak in 2nd year)
• Fall & winter
• Etiology
  • Parainfluenza (50%), RSV, rhinovirus
    • Consider diphtheria if not immunized
• Must rule-out foreign body

Diagnosis

1. 1-2 day of URI followed by barking cough, stridor
2. Low-grade fever
3. NO drooling or dysphagia
4. Duration = 3-7d, most severe on days 3-4

Croup Score

Inspiratory stridor None 0 points

When agitated 1 points 
On/off at rest 2 points 
Continuous at rest 3 points 

 

Retractions None 0 points

Mild 1 points 
Moderate 2 points 
Severe 3 points 

 

Air entry Normal 0 points

Decreased 1 points 
Moderately decreased 2 points 
Severely decreased 3 points 

 

Cyanosis None 0 points

When crying 2 points 
At rest 3 points 

 

Alertness Alert 0 points

Restless, anxious 2 points 
Depressed 3 points 

Assessment <2 Very mild 2-9 Mild to moderately severe >9 Severe croup

Work-Up

1. Consider CXR if concerned about alternative dx
   1. Steeple sign on AP (not Sp, not Sn)
2. Consider nasal washings for RSV, parainfluenza, influenza.

Treatment

1. Steroids
   1. Give to all pts with croup
      1. Dexamethasone 0.15-0.6mg/kg PO/IM (max 10mg)
2. Epineprhine (nebulized)
   1. Give for moderatate-severe cases
3. Do NOT give albuterol (may worsen edema (vasodilation))

Disposition

1. Consider discharge if:
   1. 3hr since last epinephrine
   2. Able to tolerate PO
   3. Nontoxic apperance

Source

Tintinalli