Talk:Croup

Rarely?

"Hospitalization is rarely required." Really? Hospitalization is frequently required for the croup cases I see in the ED. What is meant by "rarely," and based upon what data? —Preceding unsigned comment added by 67.163.139.11 (talk) 00:30, 27 August 2010 (UTC)

Your observation is biased, and does not take into account cases of croup seen at doctor's offices, who don't go to the ED. Obviously, some people use the ED as a primary care source, but many more go because it is an emergency situation. —Preceding unsigned comment added by 67.246.37.251 (talk) 03:50, 14 January 2011 (UTC)

Steam treatment

Try sitting with your child in a bathroom with the door closed. Run the shower or bath with HOT water to build up steam. It takes about 10 minutes, but the steam improves the croup tremendously, particularly if the child is having a croup "attack." 67.170.210.23 15:29, 17 December 2006 (UTC)

According to the NEJM review which Jfdwolff cited, this procedure has no effect on croup. It cited a Cochrane review, among others.

In any case, Wikipedia does not prescribe medicine. Nbauman (talk) 21:15, 12 February 2008 (UTC)

According to many thousands of parents, it works wonders, and quickly. My reasons for posting this are that, when a cited study is flawed, as is plainly the case with so much anecdotal evidence contradicting its findings, editors need to be on the lookout for reports that challenge the earlier, flawed study. (Much like the vanity study which concluded mercury-based vaccine preservatives cause autism was directly contradicted by many dozens of other more recent studies.) In particular, it needs to be established who provided the funding for the study. On your second point, yes Wikipedia isn't WebMD.com, but it should be driving right to the heart of accuracy; and the article as it stands misleads readers by repeating wholly false information.--Rfsmit (talk) 19:27, 26 August 2009 (UTC)

That part of the article contradicts itself. See the in-line comments I've added. microchip08 (talk) 17:42, 7 March 2008 (UTC)

I would like somebody to cite that osteopathy is a useful treatment for Croup. I see nothing in the literature that would back this up and it is potentially dangerous advice. —Preceding unsigned comment added by Sdbaral (talk • contribs) 22:22, 20 October 2008 (UTC)

Steam treatment is not considered dangerous and is commonly recommended by standard handouts from AAP, standard phone protocols and used in hospitals. Highest evidence is certainly RCT that meets Cochrane review standards. Failing that, prevailing standards of care should be considered. Oregonkc (talk) 00:50, 11 August 2010 (UTC)

We have two excellent references that state it has not been found to be useful and currently say "Inhalation of hot steam or humidified air is a traditional self-care treatment, but clinical studies have failed to show effectiveness.[3][6"Doc James (talk · contribs · email) 04:42, 11 August 2010 (UTC)

Doc James is absolutely right that there is good evidence that steam treatment does not work. The idea that we throw out large randomized controlled trials when "anecdotal evidence contradict[s] its findings" misunderstands the role of evidence in medicine, to put it politely. That said, it seems reasonable to not that steam treatment continues to be recommended by many professionals despite the studies. For example, one might say: ""Inhalation of hot steam or humidified air is a traditional self-care treatment, which is still recommended by mzny physicians and the american Academy of Pediatrics, but clinical studies have failed to show effectiveness." I think that gives a more complete picture of where we are. —Preceding unsigned comment added by 67.163.139.11 (talk) 00:22, 27 August 2010 (UTC)

NEJM review

Clinical practice JFW | T@lk 06:52, 24 January 2008 (UTC)

Vaccines

The article says that "Croup can be prevented by immunization for influenza and diphtheria." However, it also says that "75% of cases are caused by parainfluenza virus", and the Human parainfluenza viruses page says that no vaccines currently exist. —Preceding unsigned comment added by Ljosa (talk • contribs) 11:45, 1 June 2009 (UTC)

75% of cases are now due to parainflenza as we now immunize and do not have cases due to diphtheria. Doc James (talk · contribs · email) 19:22, 21 April 2010 (UTC)

GA Review

This review is transcluded from Talk:Croup/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: WhatamIdoing (talk) 04:10, 30 July 2010 (UTC)

1. Well written?:

The grammar is fine, and I've fixed a couple of things that might have been unclear.

The classification system isn't very well explained. I don't think that a typical reader will understand that the unlabeled numbers at the top are points assigned, and that you add them up to get the score. It looks more like "moderate" is "stage 2", and then you have all of the symptoms in the "2" column. I don't (unfortunately) have a particularly good suggestion for how to fix it. I'm open to any suggestions.

I don't think that the average reader will understand what it means for a patient to 'appear toxic'. I couldn't find an appropriate wikilink (which I think would be sufficient). Perhaps a very brief description could be substituted for this jargon?

Optionally, it seems to me that the ==Classification section== should be placed lower on the page (because a staging system used only for research isn't very important).

Optionally, when discussing the success of vaccination in reducing respiratory diseases, and therefore croup, it might be appropriate to re-point the wikilinks away from the diseases (e.g., influenza) in favor of the vaccinations (e.g., flu jab).

Optionally, editors here may want to consider consistent compliance with MOS:DASH (e.g., using en dashes for ranges of numbers). (This is not required by the WP:Good article criteria.)

2. Factually accurate?:

Overall, this article has a density of inline citations that goes well beyond the actual requirements of the WP:Good article criteria. I am particularly pleased to see the reliance on high-quality secondary sources: This is a good instance of quality over quantity.

I'm not convinced that croup is an acute viral infection (which is what the lead says): I think it is a medical condition that is (now) (among vaccinated persons) most frequently triggered by acute viral infections. It is not actually possible for croup to be (a) an acute viral infection and (b) occasionally caused by diphtheria. Consequently, the lead will need to be re-written to be more accurate in the definition.

I don't have access to the two sources that are most frequently cited, but the claims they support are consistent with what other sources say, and thus I have no concerns about unverifiable claims or original research.

3. Broad in coverage?: ✓ Pass

This article addresses all of the major points that are represented in the sources. It doesn't go into much detail about some of them, but detail is not actually required by the WP:Good article criteria.

4. Neutral point of view?: ✓ Pass

Neutrality isn't particularly difficult to achieve on a basic medical topic like this, and this article has done well on this point.

It does tend to lean a bit towards the emergency department/hospital perspective, and since many cases of (mild and moderate) croup are seen in a regular office/non-emergency situation, this may not always be appropriate. However, I couldn't identify any specific instance that was inappropriate, and so I've concluded that I worried needlessly about this.

5. Article stability? ✓ Pass

The article is stable; very few changes have been made during the last month.

6. Images?: ✓ Pass

The image is relevant and has an appropriate license.

Other comments

IMO this article is exactly the sort of shorter article that the WP:Good article criteria is intended to accept. It is concise but basically complete. If you have an interest in advancing it to WP:Featured article status, it will probably require a significant expansion.

I've marked the three problems that need to be resolved with a yellow "warning" icon. If we can get those resolved in the next few days, then I'll happily pass this article. WhatamIdoing (talk) 05:30, 30 July 2010 (UTC)

Many thanks for the review. I have changed "toxic appearance" to "very sick appearance". Have clarified how one uses the table in the text. Agree that yes technically croup is trigger usually by an acute viral infection. In the medical literature the definition of croup varies between sources. Would be happy to provide the sources if you wish. I have never understood the different uses of dashes and have trouble finding that long one on my keyboard. Would appreciate if someone with experience in these things could make sure this article is compliant. Have linked immunization in the text. Doc James (talk · contribs · email) 07:13, 30 July 2010 (UTC)

Are diphtheria and bacterial tracheitis really still referred to as "croup"? I was under the impression (viral) ALTB had been distinguished from bacterial illnesses for decades. I don't have access to the NEJM review, but I'd be very surprised if it actually refers to "bacterial croup" and defined croup as a complex or constellation of illnesses (including diphtheria) rather than a viral infection. Fvasconcellos (t·c) 14:00, 30 July 2010 (UTC)

The sources cited in the article tend to say things like "Croup is a common childhood upper airway disorder caused by a viral infection," rather than 'Croup is itself a viral infection' or 'Croup is always caused by a virus'. It seems that croup is the syndrome/constellation of signs and symptoms (whatever the cause), rather than a particular type of infectious disease. WhatamIdoing (talk) 01:06, 1 August 2010 (UTC)

(undent) Uptodate says:

INTRODUCTION — Croup is a respiratory illness characterized by inspiratory stridor, cough, and hoarseness. These symptoms result from inflammation in the larynx and subglottic airway. A barking cough is the hallmark of croup among infants and young children, whereas hoarseness predominates in older children and adults. Although croup usually is a mild and self-limited illness, significant upper airway obstruction, respiratory distress, and, rarely, death, can occur.

The clinical features, evaluation, and diagnosis of croup will be discussed here. The management of croup is discussed separately. (See "Approach to the management of croup" and "Pharmacologic and supportive interventions for croup".)

DEFINITIONS — The term croup has been used to describe a variety of upper respiratory conditions in children, including laryngitis, laryngotracheitis, laryngotracheobronchitis, bacterial tracheitis, or spasmodic croup [1]. These terms are defined below. In the past, the term croup also has been applied to laryngeal diphtheria (diphtheritic or membranous croup) which is discussed separately. (See "Epidemiology and clinical features of diphtheria" and "Diagnosis and treatment of diphtheria".)

Doc James (talk · contribs · email) 12:24, 1 August 2010 (UTC)

Thanks—I guess I was thrown off by the mention of diphtheria cited to a recent review.

Speaking of recent and historical, have you considered adding a "History" section to the article? :) It is by no means a requirement for GA status (and, hey, I'm not reviewing the article), but I'd love to see a couple of separate paragraphs. Maybe the current sources are enough to draw from? Fvasconcellos (t·c) 16:00, 1 August 2010 (UTC)

Will see what I can come up with. Doc James (talk · contribs · email) 22:20, 1 August 2010 (UTC)

Moving respiratory score section: Agree this should be moved further down the article or listed as a subheading under signs/symptoms. The score system is useful out side of research setting but would be more useful to health care provider than general public. General public that needs a quick understanding of disease process would need to be quickly led to signs/symptoms to better understand the disease. Oregonkc (talk) 00:53, 11 August 2010 (UTC)

I prefer keeping the standard lay out for disease articles as discussed here WP:MEDMOS. Thus people who use Wikipedia frequently will always know were to find what they are looking for.Doc James (talk · contribs · email) 04:43, 11 August 2010 (UTC)

The standard order says that it's appropriate to rearrange things on occasion; this might be one of the occasions. (Merging it into the symptoms section is another possibility.)

Have you decided whether you want to add a history section? WhatamIdoing (talk) 04:49, 11 August 2010 (UTC)

Yes one can rearrange things. I know a few other editors occasionally do. I however believe the importance of a consistent structure is more important than this small change in order. If others believe strongly that merging with signs and symptoms would be an improvement I do not have any real concerns. I have started work on a section dealing with history. Doc James (talk · contribs · email) 05:16, 11 August 2010 (UTC)

FWIW, I do feel either merging with signs and symptoms or moving down would be an improvement. Fvasconcellos (t·c) 06:42, 11 August 2010 (UTC)

Or maybe merging it into the end of ==Diagnosis==. WhatamIdoing (talk) 17:30, 11 August 2010 (UTC)

I've reviewed the new history section, and it passes on all points. Thanks for adding that: I think it provides interesting information. WhatamIdoing (talk) 17:43, 11 August 2010 (UTC)

I have merged to diagnosis as recommended as the score is used to determine the degree of severity.Doc James (talk · contribs · email) 17:56, 11 August 2010 (UTC)

I like the way it works in that section.

Any last complaints before I formally promote this? WhatamIdoing (talk) 18:10, 11 August 2010 (UTC)

Since all of my issues were addressed, and since no one raised any further issues, I have promoted the article. Congratulations and sincere thanks to all of the editors who helped write and improve this article. WhatamIdoing (talk) 21:44, 12 August 2010 (UTC)

Why does "pseudocroup" redirect here?

Not mentioned in article. 86.179.191.90 (talk) 01:50, 8 February 2015 (UTC)

It is a history term. Will explain in the history section. Doc James (talk · contribs · email) 10:00, 8 February 2015 (UTC)

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Prevention

I think it would be worthwhile to mention the research which indicates that emotional, physical, and mental well-being contribute greatly to health. I recall a college course that mentioned a study where they injected the participants with some sickness but not all got sick because some had good relationships, ate well, slept well, etc. Lifestyle health is the long-term solution to these diseases and sicknesses. Derekbr1gham (talk) 13:22, 16 November 2017 (UTC)

Please read WP:MEDRS Doc James (talk · contribs · email) 16:55, 19 November 2017 (UTC)

Terminology

We generally use the modern meaning of words. The current meaning of croup is for a viral infection. Yes many years ago the terms were used in a slightly different way and this article addresses that in Croup#History. Doc James (talk · contribs · email) 11:26, 14 May 2019 (UTC)

Cold shock treatment

A folk treatment is known, when the child is briefly immersed in very cold water then, without delay, intensely rubbed (with a towel or like that), dressed in comfortably warm clothes and placed in a comfortably warm room. I don't know, whether it is a sham treatment or an effective one (but, probably, a dangerous), but it should be covered anyway. Эйхер (talk) 11:40, 13 December 2019 (UTC)

Why does this article sound like only children can be affected by croup?

Am I missing something or does the article strongly imply that this is a "children's illness" that only concerns pediatrics? 74.196.235.209 (talk) 13:00, 4 May 2021 (UTC)

It is not common in adults. It is most common in young children (babies and toddlers). WhatamIdoing (talk) 03:02, 6 May 2021 (UTC)

@WhatamIdoing: Is the reason for that known? Surely adults are able to be infected with the viruses and bacteria that cause croup. Do adults simply present with different symptoms than the hoarse cough associated with croup? —Mahāgaja · talk 13:59, 1 March 2022 (UTC)

@Mahagaja, I understand that the characteristic cough depends on the size of the airway (when it's swollen). The smaller your airway, the less swelling it takes to become really narrow. The bigger your airway (e.g., a typical adult) the less likely you are to reach that point. WhatamIdoing (talk) 16:52, 1 March 2022 (UTC)