Croup/Stridor: Evaluation & Treatment
Pathophysiology: Inflammation in the larynx and subglottic airway often due to a viral infection with Parainfluenza virus type 1 being the most common. Host risk factors include: functional or anatomic upper airway narrowing, variations in immune response, and predisposition to atopy
Epidemiology: most common in children 6 months to 3 years old. uncommon in >6y/o. Family history is a risk factor.
Signs/Symptoms: inspiratory stridor, cough, and hoarseness. barking cough is the hallmark among infants, whereas hoarseness predominates in older children and adults.
Diagnosis: clinical. XR not generally required, but PA chest radiograph will show subglottic narrowing, commonly called the "steeple sign"
Management: if stridor at rest or distressed, administer racemic epi and give steroid (often Dexamethasone orally if able). Avoid aggitated child as much as possible. The Westley croup score can be used to assess severity.
Critical Times for Affected Patients: Impending respiratory failure (Westley croup score ≥12) requires prompt recognition and treatment. CRNAs are on call and available to help with difficult airway intubations, if required.
- Bhat, N. et al. A Prospective Study of Agents Associated with Acute Respiratory Infection among Young American Indian Children. Pediatr Infect Dis J. 2013 Aug; 32(8): e324–e333. doi: 10.1097/INF.0b013e31828ff4bc
- Ortiz-Alvarez, O. Acute management of croup in the emergency department. Paediatr Child Health. 2017 Jun; 22(3): 166–169. doi: 10.1093/pch/pxx019
- "Glucocorticoids for croup in children." Cochrane Systematic Review. 2018 Aug. (concluded reduced symptoms within 2 hours of glucocorticoids)
- Croup/Stridor (Pediatric) YKHC Clinical Guideline