The Syracuse
croup scoring system was validated in 165 children with
croup who were admitted to an intensive
therapy unit for assessment over a one year period. The unit served as a
croup triage point for Cardiff and its environs. A score of > 5 was taken as an indication that a patient was at risk of upper
airway obstruction and was used to support a triage decision by the junior hospital doctor to admit a patient to the intensive
therapy unit. All patients with an initial score < or = 5 were considered safe for transfer to a general paediatric ward and none of these required subsequent admission to
intensive care. This score was then tested on a further 134 children with
croup, in order to identify those patients who required specialised monitoring, observation or treatment in
intensive care. A score of > 5 gave a specificity of 100% and a sensitivity of 80%.
Croup scoring continued after admission on the general paediatric wards. Two patients who were originally admitted to the intensive
therapy unit with a score > 5 improved within 6 h and were transferred to the general ward with a score < or = 5. These children subsequently required readmission to the intensive
therapy unit. Our tracheal intubation rate of 2% was low and may relate to the routine use of regular
adrenaline nebulisation. We recommend this scoring system to other paediatric departments for initial triaging decisions and for documenting progress on the wards.