Westley Croup Score

Scores croup severity using the five-component Westley scale (1978): level of consciousness, cyanosis, stridor, air entry, and retractions, summed from 0–17. Higher scores indicate more severe upper-airway obstruction and impending respiratory failure.

Pediatrics PediatricsEvidence-BasedUpdated 2026-08-16

Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.

Clinical Notes

The Westley croup score (1978) quantifies severity of viral laryngotracheobronchitis (croup) using level of consciousness, cyanosis, stridor, air entry, and chest-wall retractions. Mild croup (score ≤ 2) is typically managed as an outpatient with a single dose of dexamethasone; moderate croup (3–7) adds nebulized epinephrine when stridor is present at rest; severe croup (≥ 8) implies impending respiratory failure with marked retractions, cyanosis, or depressed consciousness and requires urgent airway management and ICU support. The score is a research and bedside severity tool, not a substitute for continuous clinical reassessment.

Calculator Information

Specialty

Pediatrics

📋 Reference Ranges

Normal Range

0–17; ≤ 2 mild, 3–7 moderate, ≥ 8 severe. Severe croup indicates impending respiratory failure and requires urgent airway management.

Reference ranges for this calculator
Classification	Range
Mild Outpatient management typically safe	0–2
Moderate Consider dexamethasone ± nebulized epinephrine	3–7
Severe Impending respiratory failure; urgent/ICU management	8–17

What This Calculator Measures

Scores the severity of viral croup (laryngotracheobronchitis) using the five-component Westley scale (1978): level of consciousness, cyanosis, stridor, air entry, and chest-wall retractions, for a total of 0–17. Higher scores indicate more severe upper-airway obstruction.

How to Use

Assess each component while keeping the child calm to avoid worsening stridor.
For stridor and cyanosis, score the worst finding seen both when calm and when agitated.
Sum the five components (0–17) and review the severity band.

How the Calculation Works

The Westley croup score sums five components: level of consciousness (0-5), cyanosis (0-5), stridor (0-2), air entry (0-2), and retractions (0-2), for a total of 0-17. Higher scores indicate more severe croup.

Variables Explained

Level of Consciousness

Consciousness, scored 0 (normal), up to 5 (reduced level).

Cyanosis

Cyanosis, scored 0 (none), 4 (with agitation), or 5 (at rest).

Stridor

Stridor, scored 0 (none), 1 (with agitation), or 2 (at rest).

Air Entry

Air entry, scored 0 (normal), 1 (decreased), or 2 (markedly decreased).

Retractions

Chest wall retractions, scored 0 (none), 1 (mild), or 2 (moderate to severe).

Interpretation Guide

Scores ≤ 2 indicate mild croup, usually managed as an outpatient with a single dose of dexamethasone. Scores 3–7 indicate moderate croup, adding nebulized epinephrine for stridor at rest. Scores ≥ 8 indicate severe croup with impending respiratory failure requiring urgent airway management and intensive care.

Age-specific interpretationPediatric ranges differ

Clinical Significance

Croup is the most common cause of acute upper-airway obstruction in children; a standardized severity score guides dexamethasone and epinephrine use, admission decisions, and early recognition of impending respiratory failure.

When It Is Useful

Emergency department assessment of a child with barking cough and stridor
Serial monitoring of croup severity during treatment
Deciding on admission, nebulized epinephrine, and ICU involvement

When It Is Not Useful

When bacterial tracheitis, epiglottitis, foreign body, or angioedema is suspected (these progress differently and require different management)
As a replacement for continuous clinical observation of the airway

Common Mistakes

Scoring stridor as present at rest when it only appeared while the child was agitated, which inflates the total.
Calling a total of 7 severe croup when severe disease begins at 8, with 3 to 7 representing moderate disease.
Using the scale in suspected epiglottitis or foreign body, where the clinical course and required management are different.

Limitations

Component scoring is somewhat subjective and inter-observer variability exists.
Agitation during assessment worsens stridor and can falsely elevate the score.
The score captures upper-airway obstruction but not hypoxemia from other causes.

Worked Example

A 2-year-old with croup has stridor only when agitated, decreased air entry, and moderate subcostal retractions, with normal consciousness, no cyanosis, and no retractions at rest.

Inputs:

consciousness: 0

cyanosis: 0

stridor: 1

airEntry: 1

retractions: 2

Expected Result: Westley croup score 4/17 — moderate croup; dexamethasone with nebulized epinephrine for stridor at rest, observation for rebound.

Evidence & References

Source:: Original Description and Lancet Review
Reference:: 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):484-487. Bjornson CL, Johnson DW. Croup. Lancet. 2008;371(9609):329-339.
Content updated:: 2026-08

Westley CR, et al. Am J Dis Child. 1978;132(5):484-487.
Bjornson CL, Johnson DW. Lancet. 2008;371(9609):329-339.

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;132(5):484-487. (Original Description)
Bjornson CL, Johnson DW. Croup. Lancet. 2008;371(9609):329-339. (Review)

Frequently Asked Questions

When is nebulized epinephrine indicated?

Nebulized epinephrine is indicated for stridor at rest (moderate-to-severe croup). A single dose of dexamethasone should be given to essentially all children with croup.

How high does the score need to be before admission?

Persistent stridor at rest, hypoxemia, or a score in the moderate-to-severe range (3 or higher with concerning features, ≥ 8 for severe) generally warrant admission for observation and treatment.

Disclaimer: This calculator is intended for educational and clinical decision support purposes only. A child who is drowsy or cyanotic at rest has critical obstruction regardless of the score; continuous airway reassessment is mandatory.