Paediatric respiratory distress — the imaging and severity-score viva

Croup is a bedside diagnosis — labs and films add little. Laboratory studies are seldom needed; viral cultures and rapid antigen tests have minimal impact and are not routine. A careful history and examination confirms croup and rules out tracheitis and rare obstructions.^[1][14]

Bronchiolitis films add little too. Diagnostic laboratory and radiographic tests play a limited role in most cases; disposition follows repeated rate, work, saturation and feed reads.^[21]

Scoring croup — the Westley anchors. Maximum 17 points; mild is 2 or below; steroids gain 1.2 points at 6 hours. The score drives the epinephrine decision and disposition.^[2]

Management synthesis — dexamethasone for all severities (0.6 mg/kg single oral dose in the mild trial; 0.15 equally effective in moderate to severe). Add nebulised epinephrine for moderate to severe (transient 30-minute relief, racemic equals L); observe 2 to 4 hours; discharge when settled with a reliable carer.^[2][4][14]

The can't-miss trap — the febrile toxic non-responder is bacterial tracheitis, not croup; the toxic stridulous child is epiglottitis in the differential; the clear choking history is foreign body with a low bronchoscopy threshold and rigid gold standard. All demand early recognition of obstruction — never agitation.^[8][9][14]