Westley Croup Score Calculator

Westley Croup Score Calculator for Pediatrics. The conventional bands are mild (0 to 2), moderate (3 to 7), severe (8 to 11), and impending respiratory failure (12 or higher). A score of 2 or less describes the large majority of croup and generally needs only a single dose of corticosteroid and reassurance. Scores of 3 to 7 support corticosteroid plus nebulized epinephrine with a period of observation for rebound. Scores of 8 or above flag a child at risk for decompensation who needs close monitoring, repeated epinephrine, and escalation planning; 12 or above (driven by depressed consciousness or cyanosis) signals a potentially failing airway requiring senior airway and critical-care involvement. The score guides disposition and intensity of therapy, not the decision to give steroids, which benefit nearly all severities.

How this calculator works

The Westley score grades acute laryngotracheobronchitis severity by summing five clinical observations, each weighted by physiologic importance: level of consciousness (normal 0, disoriented 5), cyanosis (none 0, with agitation 4, at rest 5), stridor (none 0, audible with agitation 1, audible at rest 2), air entry (normal 0, decreased 1, markedly decreased 2), and retractions (none 0, mild 1, moderate 2, severe 3). The total ranges from 0 to 17, with the heaviest weights deliberately assigned to hypoxia and altered mental status because those signal impending airway compromise rather than simply noisy breathing. It is a physical-exam instrument only; no imaging, oximetry number, or laboratory value feeds the score.

When to use this calculator

Use it in the emergency department or ward to quantify severity in a child (typically 6 months to 6 years) with the barky cough, hoarseness, and inspiratory stridor of viral croup, and to track response after treatment such as nebulized epinephrine or corticosteroid. It is most valuable for standardizing serial reassessment and communication rather than making the diagnosis. Do not apply it to stridor from a competing cause: suspected epiglottitis, bacterial tracheitis, retropharyngeal abscess, foreign body, or angioedema all demand their own pathways, and a toxic or drooling child should never be reduced to a croup number.

Inputs used

  • Consciousness
  • Cyanosis
  • Stridor
  • Air entry
  • Retractions

Clinical interpretation

The conventional bands are mild (0 to 2), moderate (3 to 7), severe (8 to 11), and impending respiratory failure (12 or higher). A score of 2 or less describes the large majority of croup and generally needs only a single dose of corticosteroid and reassurance. Scores of 3 to 7 support corticosteroid plus nebulized epinephrine with a period of observation for rebound. Scores of 8 or above flag a child at risk for decompensation who needs close monitoring, repeated epinephrine, and escalation planning; 12 or above (driven by depressed consciousness or cyanosis) signals a potentially failing airway requiring senior airway and critical-care involvement. The score guides disposition and intensity of therapy, not the decision to give steroids, which benefit nearly all severities.

Worked example

A 2-year-old is alert (0), pink on room air (0), has stridor audible at rest (2), mildly decreased air entry (1), and moderate chest-wall retractions (2). Total = 5, placing the child in the moderate band. This warrants dexamethasone plus nebulized epinephrine with observation; if a repeat score 2 to 4 hours later falls to 1 to 2 with sustained improvement and no rebound stridor after the epinephrine wears off, the child can usually be discharged.

Limitations and safety notes

The score was derived and validated on hospitalized children and its bands are pragmatic conventions rather than rigorously outcome-calibrated thresholds, so a low number never overrides a worrying clinical trajectory. Retractions and air entry are subjectively rated, producing meaningful inter-observer variation, and a single measurement misses the dynamic nature of croup, where a child can worsen after epinephrine wears off. Critically, it assumes the diagnosis is croup; applying it to epiglottitis, tracheitis, or an inhaled foreign body can falsely reassure. It also does not incorporate hypoxia by pulse oximetry, hydration, or degree of respiratory fatigue, all of which can shift management independent of the total.

Frequently asked questions

Does a low Westley score mean I can skip corticosteroids?

No. Even mild croup (score 0 to 2) benefits from a single dose of dexamethasone, which reduces return visits and speeds symptom resolution. The score guides how much additional therapy and observation are needed, not whether to give steroids.

When should I add nebulized epinephrine?

Epinephrine is generally reserved for moderate-to-severe disease (roughly score 3 or higher, and especially 8 or higher) with stridor at rest. Because its effect wears off within a couple of hours, observe the child for rebound stridor before considering discharge.

Which two components carry the most weight and why?

Level of consciousness (up to 5 points) and cyanosis (up to 5 points) dominate the scale because altered mentation and hypoxia mark impending airway failure, whereas loud stridor alone caps at 2 points and does not by itself indicate a critical airway.

Can I use the score to diagnose croup?

No. It only quantifies severity once croup is the working diagnosis. Toxic appearance, drooling, high fever, or a poor response to standard treatment should prompt consideration of epiglottitis, bacterial tracheitis, or a foreign body instead.

What score supports safe discharge?

There is no rigid cutoff, but children who settle to a score of 1 to 2 with resolved resting stridor, adequate air entry, normal oxygenation, and no rebound after epinephrine has worn off are typically dischargeable with corticosteroid already given and clear return advice.

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. PMID: 347921.
  • Bjornson CL, Klassen TP, Williamson J, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. 2004. PMID: 15385657.

Editorial review and citation methodology

Reviewed by the Quick Medical Calculator Editorial Team. Last reviewed: June 16, 2026. The review checks calculator inputs, intended population, interpretation, limitations, and source alignment.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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