Westley Croup Score

Evaluates croup severity based on respiratory and general symptoms, for clinical and research purposes.

In the text below the tool there is more information on the score and on the studies behind it.

The Westley Croup Score stratifies croup severity in pediatric patients based on respiratory symptoms.

The score is used both in clinical settings and in research studies. There are 5 variables considered:

■ Level of consciousness;

■ Air entry;

■ Cyanosis;

■ Chest wall retractions;

■ Inspiratory stridor.

The original study looked at the clinical response of nebulized racemic epinephrine vs saline dating in croup pediatric patients.

It consisted of a cohort of 20 patients and was followed by 2 validation studies.

Score results assign the patient to one of the 4 croup severity categories:

■ Mild (0 – 2 points);

■ Moderate (3 – 5 points);

■ Severe (6 – 11 points);

■ Extremely severe (12 – 17 points).


Level of consciousness


Air entry




Chest wall retractions


Inspiratory stridor

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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


Westley Croup Score items

The Westley model (addressed to pediatric patients from 3 months to 12 years) is used in clinical settings to diagnose respiratory diseases and measure the severity of croup.

In research settings, the score has been applied in studies assessing post extubation upper airway obstruction.

The score consists of 5 items that are presented, along their answer choices and number of points, in the table below:

Score item Answer choices (points)
Level of consciousness Normal (0)
Disoriented (5)
Air entry Normal (0)
Decreased (1)
Markedly decreased (2)
Cyanosis None (0)
With agitation (4)
At rest (5)
Chest wall retractions None (0)
Mild (1)
Moderate (2)
Severe (3)
Inspiratory stridor None (0)
With agitation (1)
At rest (2)

Westley Croup Score interpretation

Once all the questions have been answered to, a final score and a degree of croup severity are given.

The degree of severity and its description are presented in the following table, along the result in points they are associated to.

Westley score Croup severity Description
0 – 2 points Mild Occasional barking cough;
No or mild suprasternal and/or intercostal retractions;
No or limited stridor at rest.
3 – 5 points Moderate Little distress or agitation;
Frequent barking cough;
Suprasternal and sternal wall retraction at rest;
Easily audible stridor at rest.
6 – 11 points Severe Significant distress and agitation;
Present barking cough;
Marked sternal wall retractions;
Prominent inspiratory and expiratory stridor.
12 – 17 points Extremely severe - Impending respiratory failure Lethargy or decreased level of consciousness;
Barking cough (frequently non prominent);
Dusky complexion without supplemental oxygen;
Sternal wall retractions (may or may not be present);
Audible stridor while at rest (sometimes hard to hear).

About the study

Dr Westley created the score in 1978 following a study on the clinical response of nebulized racemic epinephrine vs saline dating.

The severity interpretation, with the mild, moderate, severe and extremely severe classification was created years later.

The original study consisted of 20 subjects (aged 4 months to 5 years), whilst the validation cohorts were of 19 and 54 patients.

In all studies, the methodology was prospective double-blind, randomized, placebo-controlled trials.

The subjects, with acute croup and persistent inspiratory stridor at rest were randomly assigned to one of two treatment groups: saline or racemic epinephrine, both nebulized and delivered by intermittent positive pressure breathing.

The finding was that nebulized racemic epinephrine is effective treatment for acute croup.


Croup guidelines

Croup of acute tracheolaryngobronchitis is a common respiratory disease, in most cases caused by the Human Parainfluenza virus, a respiratory pathogen.

There are two subtypes: acute laryngotracheitis and spasmodic croup. The former consists in febrile state and occurs in patients with a history of upper respiratory tract infections while the latter consists in afebrile patients with more transient symptoms.

Croup affects children (rarely occurs in adults) with 3% of children before age 6 acquiring it every year.

In less than 5% of cases hospitalization is needed as most symptoms can be treated ambulatory.

The condition debuts abruptly with barking cough, inspiratory stridor, hoarseness. These are accompanied by general respiratory distress due to upper airway obstruction.

The symptoms are in most patients of mild intensity and last only a couple of days.

Left untreated, croup can lead to complications and even respiratory failure and arrest due to hypoxia and hypercapnia.

Treatment includes humidified air therapy, racemic epinephrine or glucocorticoid medication and is aimed at relieving symptomatology.


Original study

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.


1. Super DM, Cartelli NA, Brooks LJ, Lembo RM, Kumar ML. A prospective randomized double-blind study to evaluate the effect of dexamethasone in acute laryngotracheitis. J Pediatr. 1989; 115(2):323-9.

2. Klassen TP. Croup. A current perspective. Pediatr Clin North Am. 1999; 46(6):1167-78.

Specialty: Otolaryngology

System: Respiratory

Objective: Evaluation

No. Of Items: 5

Year Of Study: 1978

Article By: Denise Nedea

Published On: March 15, 2017

Last Checked: March 15, 2017

Next Review: March 9, 2023