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Westley croup score

Also called croup severity score, Westley score, laryngotracheobronchitis score

Five-item (0–17) severity score for croup: stridor, retractions, air entry, cyanosis and level of consciousness.

Inspiratory stridor
Retractions
Air entry
Cyanosis (room air)
Level of consciousness

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Formula and scoring

Stridor 0/1/2 (none, agitated, rest) + retractions 0/1/2/3 + air entry 0/1/2 + cyanosis 0/4/5 (none, agitated, rest) + consciousness 0/5 (normal, disoriented). Bands: ≤2 mild, 3–5 moderate, 6–11 severe, ≥12 impending respiratory failure.

Exam and ward pearls

  • Cyanosis and altered consciousness carry 4–5 points each, so either alone moves the child to severe.
  • Westley devised the score in 1978 for a racemic-epinephrine trial; it remains the standard outcome measure in croup trials.
  • Croup is a clinical diagnosis; the steeple sign on X-ray is typical but not pathognomonic.

When not to rely on it

  • Severity bands differ between sources (some use 3–7 moderate, 8–11 severe, or 0–3 / 4–6 / >6); the item points are the same everywhere.
  • A quiet child with falling stridor may be tiring, not improving.

Source

  1. 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):484-7. doi:10.1001/archpedi.1978.02120300044008 · PMID 347921
  2. Hey F, Lieftüchter V, Olivieri M, Zimatschek S, Hoffmann F, Pfeiffer D. Treatment pathways and rebound-rate of prehospital viral croup attacks: a prospective observational follow-up study. Front Pediatr. 2025;13:1544480 (Table 1 and bands ≤2 / 3–5 / 6–11 / ≥12). doi:10.3389/fped.2025.1544480 · PMID 40421306
  3. Alharbi AS, Yousef AA, Alharbi SA, et al. Application of aerosol therapy in respiratory diseases in children: a Saudi expert consensus. Ann Thorac Med. 2021;16:188-218 (Table 7: mild 0–2, moderate 3–5, severe 6–11). doi:10.4103/atm.atm_74_21 · PMID 34012486

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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