What criteria should I use to determine whether a patient with epiglottitis requires urgent referral to secondary care?

Criteria for urgent referral of a patient with epiglottitis to secondary care include:

• Signs of respiratory distress such as severe respiratory difficulty, stridor, or inability to maintain oxygen saturation despite oxygen supplementation.
• Evidence of airway compromise or risk of sudden airway obstruction, including drooling, difficulty swallowing, or muffled voice.
• Any features suggesting an immediately life-threatening illness, such as altered mental state, cyanosis, or shock.
• Presence of high-risk features for severe illness or sepsis, including raised respiratory rate, low blood pressure, mottled or cyanotic skin, or non-blanching rash.
• Clinical judgement indicating the patient is seriously unwell or deteriorating rapidly.

Patients meeting any of these criteria should be referred immediately for emergency medical care, usually by ambulance, to a facility with appropriate resuscitation and airway management capabilities ³,¹.