Viral Croup: A Current Perspective

Alexander K.C. Leung, MBBS, FRCPC, FRCP (UK & Irel), FRCPCH; James D. Kellner, MD, FRCPC; David W. Johnson, MD, FRCPC

J Pediatr Health Care. 2004;18(6)

Conclusion

We advocate that all children diagnosed with croup be treated with corticosteroids. Most children can be treated by health care practitioners with a single, oral dose of dexamethasone on an outpatient basis. Those with moderate involvement may need to be assessed in an emergency department. For those who do not tolerate the oral preparation, nebulized budesonide or intramuscular dexa-methasone are reasonable alternatives. Nebulized epinephrine should be reserved for patients with moderate to severe croup. Patients should be observed for a minimum of 2 hours after treatment with epinephrine. Simultaneous administration of corticosteroid with epinephrine reduces both the rate of hospitalization and intubation in patients with severe croup and impending respiratory failure.

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Acknowledgments

We thank Ms. Vivian Shiao and Ms. Eudora Cheung for expert secretarial assistance and Mr. Sulakhan Chopra of the University of Calgary Medical Library for help in the preparation of the manuscript.

Reprint Address

Reprint requests: Dr. Alexander K. C. Leung, #200, 233-16th Ave NW, Calgary, Alberta T2M 0H5 Canada; Email: aleung@ucalgary.ca

Cite this: Viral Croup: A Current Perspective - Medscape - Nov 01, 2004.

Table 1. Westley Croup Scoring System
Symptom	Score
Level of consciousness
Normal (including sleep)	0
Disoriented	5
Cyanosis
None	0
Cyanosis with agitation	4
Cyanosis at rest	5
Stridor
None	0
When agitated	1
At rest	2
Air entry
Normal	0
Decreased	1
Markedly decreased	2
Retractions
None	0
Mild	1
Moderate	2
Severe	3

Data from Westley, C. R., et al. (1978).

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