Westley Croup Score
Classifies croup severity to guide management (dexamethasone, nebulised adrenaline, PICU).
Score interpretation
Westley ≤ 2: occasional barky cough, no stridor at rest, no or mild retractions.
→ Single dose of oral dexamethasone — take doses from a children's formulary. Reassure and safety-net; discharge home if improving.
Westley 3–7: frequent barky cough, easily audible stridor at rest, retractions at rest, little or no agitation.
→ Oral dexamethasone; observe and reassess; nebulised adrenaline if distress increases — take doses from a children's formulary. Admit if not improving after observation.
Westley 8–11: prominent stridor at rest, marked retractions, significant distress or agitation.
→ Senior paediatric review. Nebulised adrenaline and dexamethasone — take doses from a children's formulary. Oxygen if hypoxic. Involve PICU and anaesthetics early.
Westley ≥ 12: decreased level of consciousness, stridor at rest (may be quiet), retractions may lessen, dusky or cyanosed.
→ CALL ANAESTHETIST + PICU NOW. Oxygen. Nebulised adrenaline. Prepare for intubation by the most experienced airway operator. Minimise distress — keep the child with a parent.
Interpretation bands for the Westley Croup. Apply clinical judgement and local guidance.
References
- Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child. 1978;132(5):484–487.
- Bjornson CL, Johnson DW. Croup in children. CMAJ. 2013;185(15):1317–1323.
Related
Curated clinical cross-links plus same-class fallbacks.
- Dexamethasone (Paediatric) · Corticosteroid — Croup / Bacterial Meningitis / Post-Extubation Stridor / Cerebral Oedema
- Dexamethasone · Corticosteroid — ENT Inflammation / Croup
- Adrenaline IM (Paediatric — Anaphylaxis) · Adrenaline (Epinephrine) — Sympathomimetic
- Prednisolone (Paediatric) · Corticosteroid — Asthma Exacerbation / Croup / Nephrotic Syndrome / IBD
- Adrenaline (ICU — Vasopressor/Inotrope) · Catecholamine Vasopressor/Inotrope
- Dexamethasone (ICU / ARDS) · Systemic Corticosteroid
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.