Interpretation
| Result | Meaning |
|---|---|
| ≤ 2 | Mild: dexamethasone, discharge |
| 3–7 | Moderate: dexamethasone; consider nebulised epinephrine; observe |
| 8–11 | Severe: nebulised epinephrine + dexamethasone; likely admission |
| ≥ 12 | Impending respiratory failure: airway expertise, PICU |
Formula
LOC: normal 0, disoriented 5 · Cyanosis: none 0, with agitation 4, at rest 5 · Stridor: none 0, with agitation 1, at rest 2 · Air entry: normal 0, decreased 1, markedly decreased 2 · Retractions: none 0, mild 1, moderate 2, severe 3
Clinical pearls
- Developed as a research outcome measure; severity bands (≤2, 3–7, 8–11, ≥12) come from the Alberta/TOP croup guideline.
- Re-assess after nebulised epinephrine: observe at least 2 hours for rebound.
- Cyanosis or altered consciousness alone puts a child in the severe range: act on the clinical picture.
Examples
westley croup score stridor at rest, mild retractions, decreased air entry, no cyanosis, alertcroup score: stridor only when crying, normal air entry, no retractions, normal LOCwestley score disoriented child cyanosis at rest stridor at rest severe retractions markedly decreased air entry
FAQ
What Westley score is severe croup?
A score of 8–11 is severe croup and ≥12 indicates impending respiratory failure. 3–7 is moderate and ≤2 is mild.
Do all children with croup need dexamethasone?
Yes, a single dose of oral dexamethasone is recommended for all severities of croup, including mild.