Summary
Definition
History and exam
Key diagnostic factors
- aumento de síntomas con la agitación
- tos característica similar al ladrido de un perro
- de 6 meses a 6 años de edad
Other diagnostic factors
- sexo masculino
- temporada alta, fines de otoño
- síntomas prodrómicos
- aparición repentina de síntomas
- peores síntomas durante la noche
- voz ronca
- dificultad respiratoria (estridor, tiraje intercostal/esternal)
- agitación persistente
- letargo
- movimiento asincrónico de la pared torácica y abdominal
- fatiga
- signos de hipoxia (palidez o cianosis)
- signos de hipercapnia (disminución del nivel de conciencia secundario al aumento de PaCO₂)
Risk factors
- de 6 meses a 6 años de edad
- sexo masculino
- intubación previa
Diagnostic investigations
1st investigations to order
- exploración física
Investigations to consider
- radiografía anteroposterior y lateral de cuello
Treatment algorithm
leve (sin estridor en reposo)
moderada (estridor en reposo; sin agitación o letargo)
grave (estridor en reposo con agitación o letargo)
Contributors
Authors
Candice Bjornson, MSc, MD, FRCPC
Associate Professor
University of Calgary
Calgary
Canada
Disclosures
CB declares that she has no competing interests. CB is the author of several references in this topic.
David Johnson, MD
Professor
Department of Pediatrics and Physiology and Pharmacology
University of Calgary
Calgary
Canada
Disclosures
DJ declares that he has no competing interests. DJ is the author of several references in this topic.
Peer reviewers
Ken Farion, MD
Assistant Professor
Pediatrics and Emergency Medicine
University of Ottawa
Ottawa
Canada
Disclosures
KF declares that he has no competing interests.
Doreen Matsui, MD, FRCPC
Associate Professor
Departments of Paediatrics and Medicine
Children's Hospital of Western Ontario
London
Ontario
Canada
Disclosures
DM declares that she has no competing interests.
Jeremy Hull, MBBS
Consultant Paediatrician
Children's Hospital and West Wing
John Radcliffe Hospital
Oxford
UK
Disclosures
JH declares that he has no competing interests.
Steve Cunningham, MBBS, PhD
Consultant Respiratory Paediatrician
Department of Respiratory & Sleep Medicine
Royal Hospital for Sick Children
Edinburgh
UK
Disclosures
SC declares that he has no competing interests.
Donna J. Lee, MD
Pediatric Pulmonology
Joseph M. Sanzari Children's Hospital,
Hackensack Meridian Health
Hackensack
NJ
Disclosures
DL declares that he has no competing interests.
Deepak Mehta, MD, FRCS ( Oto)
Professor of Otolaryngology
Director Pediatric Aerodigestive Center,
Baylor College of Medicine,
Texas Children’s Hospital,
Houston
TX
Disclosures
DM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Johnson D, Klassen T, Kellner J. Diagnosis and management of croup: Alberta Medical Association clinical practice guidelines. Alberta: Alberta Medical Association; 2015 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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