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Referral criteria from primary care - sore throat

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Most children with recurrent sore throat can be managed in primary care. NICE has given guidance concerning referral if recurrent episodes of acute sore throat in children aged up to 15 years. NICE have suggested children should, however, be referred to a specialist service if (1):

****they have, or are suspected of having, a quinsy

****the swelling is causing acute upper airways obstruction

*** the swelling is interfering with swallowing, causing dehydration and marked systemic upset

** they have a history of sleep apnoea, daytime somnolence or failure to thrive

* they have had 5 or more episodes of acute sore throat in the preceding 12 months documented by the parent or doctor, and which have been severe enough to disrupt the child’s normal behaviour or day-to-day activity

* they have guttate psoriasis which is exacerbated by recurrent tonsillitis

+ there is suspicion of a serious underlying disorder such as leukaemia

Key to referral times:

**** immediate referral (a)

*** urgent referral (b)

** soon (b)

* routine (b)

+ times will be discretionary and depend on clinical circumstances

(a) within a day

(b) Health authorities, trusts and primary care groups should work to local definitions of maximum waiting times in each of these categories. The multidisciplinary groups considered that a maximum waiting time of 2 weeks is appropriate for the urgent category

Other suggested reasons that a patient with a sore throat may be referred include (2):

  • retropharyngeal abscess
  • acute epiglotittis
  • oropharyngeal tumour
  • recurrent tonsillitis
  • blood dyscrasias


  1. NICE (May 2000). Referral Practice A guide to appropriate referral from general to specialist services.
  2. McCartney D. Sore throat. Update 1996: 202-4.

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