Croup

Question 1

What is croup?

Answer 1

Viral upper respiratory tract infection which results in mucosal inflammation anywhere between the nose and the trachea

Question 2

What are the most common viral causes of croup?

Answer 2

Parainfluenza virus - 1,2,3,4
Respiratory syncytial virus 
Adenovirus
Rhinovirus
Enterovirus
Measles
Meta pneumovirus
Influenza A and B 
Mycoplasma pneumoniae

Question 3

What are the risk factors for croup?

Answer 3

Male

Autumn and spring

Question 4

What is protective of croup?

Answer 4

CD14 C-159T gene

Question 5

Describe the typical history of croup

Answer 5

1 to 4 day - non specific cough, rhinorrhoea, fever progressing to a barking cough and hoarseness
Symptoms worse at night

Question 6

What are some red flags in the history of croup suggestive of respiratory failure

Answer 6

Drowsiness

Lethargy

Question 7

Describe the examination findings of croup

Answer 7

Stridor
Chest sounds may be normal - if airflow is limited and these sounds may decrease
Resp distress - tachypnoea, tachycardia

Question 8

What are some red flags on examination of respiratory failure

Answer 8

Cyanosis
Lethargy 
Decreased level of consciousness
Laboured breathing
Tachycardia

Question 9

What do the presenting symptoms of croup vary with?

Answer 9

Severity of disease

Question 10

Give the name of the classification scoring system used in croup

Answer 10

Westley croup score

Question 11

List the classifications of croup

Answer 11

Mild
Moderate
Severe
Impending respiratory failure

Question 12

Describe mild croup

Answer 12

Score <2
Occasional barking cough
No stridor at rest
Mild/no retractions

Question 13

Describe moderate croup

Answer 13

Score 3-7 
Frequent barking cough 
Stridor at rest
Mild/moderate retractions
Distress and agitation

Question 14

Describe severe croup

Answer 14

Score 8-11
Frequent barking cough 
Stridor at rest 
Marked retractions
Significant distress and agitation

Question 15

Describe croup with impending respiratory failure

Answer 15

Score >12 
Decreased level of consciousness
Poor air entry
Stridor at rest 
Severe retractions
Pallor/cyanosis

Question 16

Which factors make up the Westley croup score?

Answer 16

Level of consciousness
Cyanosis
Stridor
Air entry 
Retractions

Question 17

Give the differential for croup

Answer 17

Epiglottitis
Inhaled foreign body 
Inhaled noxious substance 
Acute anaphylaxis 
Bacterial tracheitis 
Diphtheria 
Laryngomalacia
Peritonsillar abscess
Angioneurotic oedema 
Laryngeal mucosal lesions
Vocal cord paralysis

Question 18

Describe the differences between croup presentation and epiglottitis

Answer 18

Croup - Days, coryza preceding, barking cough, can drink, mouth closed, fever <38.5, rasping stridor, hoarse voice

Epiglottitis - Hours, no coryza preceding, slight cough, drooling, fever >38.5, soft stridor, weak/silent voice

Question 19

How is croup diagnosed?

Answer 19

Mainly clinical diagnosis
Bloods - FBC, CRP, U&Es
Pulse oximetry
CXR - rule out other differentials

Question 20

Where is mild croup mostly managed?

Answer 20

At home

Question 21

When should you consider admitting mild croup?

Answer 21

Previous history of airway obstruction 
<6months of age
Immunocompromised
Inadequate fluid intake
Poor response to initial therapy 
Uncertain diagnosis
Significant parental anxiety

Question 22

What advice should be given to parents looking after their croup kids at home?

Answer 22

Symptoms resolve within 48hrs to a week
Croup is viral illness so antibiotics are not needed
Paracetamol and ibuprofen used to control pain and fevers
Seek urgent advice if symptoms are worsening
Look out for signs of resp failure and call ambulance

Question 23

When should immediate hospital admission occur?

Answer 23

Moderate/severe croup or impending resp failure

Serious disorder caused by infection

Question 24

How should all children with croup be treated?

Answer 24

Single dose oral dexamethasone 0.15mg/kg or oral prednisolone 1-2mg/kg
Nebulised adrenaline for symptomatic relief
Keep child calm
O2 therapy as required
Contact ENT and anaesthetist if airway support needed

Question 25

List the complications of croup

Answer 25

Lymphadenitis
Otitis media
Dehydration 
Bacterial superinfection - pneumonia or bacterial tracheitis 
Pulmonary oedema and pneumothorax