The steroid odyssey in croup

Initial radiographic tracheal ratio in predicting clinical outcomes in croup in children

Croup is the leading infectious disease resulting in pediatric upper airway obstruction. Our purpose is to analyze diverse features of neck radiographs could be seen as an objective tool to predict outcomes in patients with croup. One hundred and ninety-two patients were prospectively recruited in pediatric emergency department with diagnosis of croup. The initial Westley score (WS), presence of steeple sign, extent of narrowing, and narrowing ratio on soft tissue neck radiographs were determined before and after treatments. The extent of frontal narrowing, extent of lateral narrowing, frontal ratio (FR), and lateral ratio (LR) were investigated to predict clinical outcomes in patients with croup. The extent of frontal/lateral narrowing and LR had significant correlation with outpatient status. Almost 71% of patients with FR values below 0.23 stayed in the hospital longer, whereas nearly 98% of patients with FR vales above 0.65 could be discharged. About 85% of patients with LR below 0.45 hospitalized longer. The LR and FR were significantly correlated with the severity and admission rate in croup. The LR > 0.6 and FR > 0.65 may indicate low risk in patients with croup, whereas the FR < 0.23 or LR < 0.45 may indicate the need of stay in hospital for further treatment and monitor.

Westley score and clinical factors in predicting the outcome of croup in the pediatric emergency department

BACKGROUND

Westley croup score has been generally used to assess the severity of croup. This study aimed to identify the individual factors associated with Westley score (WS) and other clinical factors in predicting the outcomes in the pediatric emergency department (PED).

POPULATION AND METHOD

We prospectively recruited patients with croup from the PED. The individual factors of WS, fever, age, and the length of hospital stay were analyzed to predict clinical outcomes. We calculated all the areas under the receiver operating characteristic (ROC) curve to determine the cutoff values of initial WS discriminating the need for admission to the wards.

RESULT

A total of 192 patients with croup were enrolled. Cyanosis and altered consciousness were not clinically significant even in patients with severe croup, whereas retraction and air entry were the major factors in WS for predicting clinical outcomes. The initial WS had a strong correlation with the length of hospital stay (r = 0.617, P < 0.001). ROC analysis showed that patients with an initial WS <2 (sensitivity, 5%; specificity, 100%; LR⁺ , 1.05; LR^- , 0; AUC, 0.87) were discharged home while the patients with an initial WS ≥5 (sensitivity, 99%; specificity, 57%; LR⁺ , 41.0; LR^- , 0.43) were more likely to require to stay in the PED. Patients with an WS ≥6 were more likely to be admitted to the wards (sensitivity, 97%; specificity, 47%; LR⁺ , 416.35; LR^- , 0.54; AUC, 0.90) CONCLUSION: Patients with an initial WS of 1-2 could be safely treated at home and those with initial WS >5 required hospitalization for further treatment.