The provided UK guidelines do not specifically address referral criteria for high-altitude cerebral edema (HACE) or high-altitude pulmonary edema (HAPE) NICE NG228,NICE NG232. However, if a patient with suspected HACE presents with severe neurological symptoms, referral to secondary care would be considered based on criteria for other acute neurological conditions NICE NG228,NICE NG232. For instance, immediate referral to an emergency department for further assessment is indicated for people with suspected subarachnoid haemorrhage who present with unexplained acute severe headache, especially a 'thunderclap' headache, or new symptoms of altered brain function such as reduced consciousness, seizure, or focal neurological deficit, along with nausea and vomiting NICE NG228. Similarly, referral to a hospital emergency department is advised for patients with a head injury who exhibit a Glasgow Coma Scale (GCS) score of less than 15, any loss of consciousness, any focal neurological deficit, a persistent headache, any vomiting episodes, or any seizure since the injury NICE NG232. The provided guidelines do not contain specific information regarding referral for high-altitude pulmonary edema (HAPE) NICE NG228,NICE NG232.
When should I consider referring a patient with suspected HACE or HAPE to secondary care?
Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.
Posted: 21 August 2025Updated: 21 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX