Croup vs Epiglottitis
Croup and Epiglottitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Croup vs Epiglottitis at a glance
- Croup: Viral upper airway infection in young children causing barking cough and stridor.
- Epiglottitis: Life-threatening supraglottic bacterial infection with risk of complete airway obstruction.
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Side-by-side comparison
| Feature | Croup | Epiglottitis |
|---|---|---|
| At a glance | Viral upper airway infection in young children causing barking cough and stridor. | Life-threatening supraglottic bacterial infection with risk of complete airway obstruction. |
| Classic presentation | Prodrome 1-3 days: rhinorrhea, mild fever, cough; Classic triad: barking 'seal-like' cough, hoarseness, inspiratory stridor (worse with agitation, crying); Symptoms often worse at night, improve during day; Mild dyspnea; respiratory distress in severe cases; Inspiratory stridor (audible without stethoscope); Suprasternal, intercostal,… | Pediatric 'four D's': dysphagia, drooling, dyspnea, dysphonia, in a toxic-appearing child sitting in tripod position. Always consider in any adult with severe sore throat plus muffled voice or stridor.; Classic adult/pediatric: rapid onset (hours) of severe sore throat, odynophagia, drooling, muffled 'hot potato' voice; Fever, often… |
| Workup / key labs | Generally clinical diagnosis — no labs required in classic presentation; Severe or atypical cases: viral PCR can identify pathogen; Pulse oximetry to assess oxygenation; Westley croup score (0-17) assesses severity using: level of consciousness, cyanosis, stridor, air entry, retractions; Mild (≤2): no/intermittent stridor; minimal… | Clinical suspicion based on presentation + visual confirmation by laryngoscopy in OR or controlled setting (cherry-red, edematous epiglottis).; Defer all blood draws and IV placement in unstable children until airway is secured (agitation can precipitate obstruction); Once airway secured: CBC (leukocytosis), blood cultures, throat… |
| Imaging | Imaging usually NOT needed; clinical diagnosis sufficient; AP neck radiograph (if obtained): 'steeple sign' — subglottic narrowing of tracheal air column (insensitive but specific); Lateral neck radiograph to exclude epiglottitis if uncertain (normal in croup) | Lateral neck soft-tissue radiograph (if patient stable): 'thumbprint sign' — enlarged, thickened epiglottis; specific but only obtain if it will not delay airway management; DO NOT delay airway intervention for imaging in unstable patient; Direct visualization with flexible fiberoptic laryngoscopy by ENT/anesthesia in controlled setting… |
| First-line treatment | Calm child — avoid agitation (worsens stridor); allow caregiver to hold; Humidified air or mist tents — historically used but lack evidence; comfort measure; Single-dose oral, IM, or IV dexamethasone 0.6 mg/kg (max 16 mg) — first-line for ALL severities (including mild); reduces ED return, duration, and admissions; Alternative oral… | Secure the airway is the priority — minimize handling, keep child calm with caregiver; Transport to OR or controlled environment with ENT and anesthesia for awake fiberoptic laryngoscopy and intubation; surgical airway (cricothyrotomy or tracheostomy) backup plan ready; Empiric IV antibiotics covering H. influenzae, S. pneumoniae, S.… |
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