When should a patient with bacterial tracheitis be referred to secondary care for further management?

While the provided guidelines do not specifically detail referral criteria for bacterial tracheitis, general principles for referring patients with suspected serious acute respiratory infections (ARIs) or serious bacterial infections to secondary care can be applied ²,³.

• For patients aged 16 and over:
• Referral for a face-to-face assessment should be arranged if a serious illness, such as pneumonia or other non-infective causes of symptoms, is suspected ².
• Consider referral if an adequate assessment cannot be made remotely, for example, due to communication difficulties ².
• Referral is also indicated if the patient has a comorbidity that could be exacerbated by an ARI (e.g., frailty, chronic obstructive pulmonary disease) or if they are immunosuppressed ². The urgency of the assessment and the referral destination should be determined by the severity of symptoms and the rate of deterioration ².
• The threshold for treatment or referral for further assessment may be lower for individuals more likely to have a poor outcome, such as those with comorbidities, multimorbidity, or frailty ².
• For children under 5 years with fever and suspected serious bacterial infection:
• Admission to hospital should be considered based on the child's clinical condition, alongside social and family circumstances, other illnesses, parental anxiety, recent travel, repeated healthcare seeking, or if a feverish illness has no obvious cause but the child remains ill longer than expected ³.
• Children who are shocked, unrousable, or showing signs of meningococcal disease require urgent review by an experienced paediatrician, with consideration for referral to paediatric intensive care ³.