How is croup severity classified with the Westley rating system?

Updated: Oct 09, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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With the Westley rating system, a sum score of less than 2 indicates mild disease. Mild disease is defined as an occasional barking cough, hoarseness, no stridor at rest, and mild or absent suprasternal or subcostal retractions. The majority (about 85%) of children who present to the emergency department have mild croup.  A sum score of 3-5 indicates moderate disease. Moderate disease findings include frequent cough, audible stridor at rest, and visible retractions, but little distress or agitation. Severe disease is indicated with a sum score range of 6-11. Patients present with prominent inspiratory (and, occasionally, expiratory) stridor, frequent cough, marked chest wall retractions, decreased air entry on auscultation, significant distress and agitation. Fortunately, severe croup is rare. A sum Westley score of ≥ 12 indicates impending respiratory failure. At this point, a barking cough and stridor may no longer be prominent. Lethargy, cyanosis, and decreasing retractions are harbingers of impending respiratory failure.

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