Symptoms and signs differentiating croup and epiglottitis
Article first published online: 21 NOV 2010
© 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 47, Issue 3, pages 77–82, March 2011
How to Cite
Tibballs, J. and Watson, T. (2011), Symptoms and signs differentiating croup and epiglottitis. Journal of Paediatrics and Child Health, 47: 77–82. doi: 10.1111/j.1440-1754.2010.01892.x
- Issue published online: 15 MAR 2011
- Article first published online: 21 NOV 2010
- Accepted for publication 5 May 2010.
Aim: To determine differentiating symptoms and signs of epiglottitis and laryngotracheobronchitis (croup).
Methods: Contemporaneous interview of parents and clinical examination of children with acute upper airway obstruction presenting to the intensive care unit of a paediatric hospital.
Results: Two hundred and three children were examined over a 40-month period. One hundred and two had croup, of whom 49 had the diagnosis confirmed at intubation and another six by direct laryngeal inspection without intubation. One hundred and one had epiglottitis of whom 95 were diagnosed by direct inspection of the larynx at intubation, five by a lateral X-ray of the neck and one on direct inspection without intubation. One child with epiglottitis died. Although both illnesses presented with stridor, the additional presence of drooling had a high sensitivity (0.79, 95% CI 0.70–0.86) and specificity (0.94, 95% CI 0.88–0.97) for epiglottitis while coughing had a high sensitivity (1.00, 95% CI 0.96–1.00) and high specificity (0.98, 95% CI 0.93–0.99) for croup. Coughing predicted croup but drooling predicted epiglottitis. Additional reliable signs of epiglottitis were a preference to sit, refusal to swallow and dysphagia. Thirty-seven percent of children with epiglottitis and 16% with croup were treated as having another respiratory illness at least once before definitive diagnosis.
Conclusions: Epiglottitis and croup are often confused because they share symptoms and signs including stridor. However, differentiation in early illness is possible by additional observation of coughing and absence of drooling in croup and by the additional observation of drooling with absence of coughing in epiglottitis.