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
• Spasmodic croup
  • Sudden onset of barking cough/stridor
  • No viral prodrome, unlike standard croup
  • Difficult to differentiate from croup
• 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. Cool mist
2. Steroids
   1. Give to all pts with croup
      1. Dexamethasone 0.15-0.6mg/kg PO/IM (max 10mg)
3. Epineprhine (nebulized)
   1. Give for moderatate-severe cases
4. Do NOT give albuterol (may worsen edema (vasodilation))
5. Intubation rarely needed
   1. Use one half size smaller tube if intubating

Disposition

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

Source

• Tintinalli
• Rosen