When is a patient with a sore throat and potential underlying conditions, such as immunodeficiency or heart disease, admissible to a healthcare facility?

Hospital Admission Criteria for Sore Throat

Admit immediately any patient with signs of airway compromise, deep space infection, or sepsis—these are life-threatening emergencies that supersede all other considerations. 1

Immediate Admission Indications

The following presentations require urgent evaluation and likely hospital admission:

Airway Compromise

• Severe difficulty swallowing or breathing indicates potential airway obstruction and requires immediate intervention 1
• Drooling, stridor, or inability to handle secretions suggests impending airway compromise 1
• Respiratory distress or stridor demands immediate attention regardless of underlying diagnosis 1

Deep Space Infections

• Peritonsillar abscess: Severe unilateral throat pain, trismus, "hot potato voice," and uvular deviation require admission for drainage and IV antibiotics 1
• Severe neck swelling or tenderness suggests deep space infection requiring urgent evaluation 1
• Parapharyngeal or retropharyngeal abscess: These require surgical drainage and cannot be managed outpatient 2

Systemic Complications

• Lemierre syndrome: Adolescents and young adults with severe pharyngitis who develop persistent fever, neck pain/swelling, and signs of sepsis require immediate admission 1. This carries a 6.4% mortality rate even with treatment 1
• Signs of sepsis (hypotension, tachycardia, altered mental status) mandate immediate admission 1

Inability to Maintain Hydration

• Inability to swallow saliva or maintain hydration requires admission for IV fluids and supportive care 1

High-Risk Populations Requiring Lower Threshold for Admission

Certain patient populations warrant a lower threshold for admission even with less severe presentations:

Immunocompromised Patients

• Any immunodeficiency increases risk of severe infections and atypical presentations, warranting consideration for admission 1
• These patients may not mount typical inflammatory responses, making clinical assessment more challenging 1

Cardiac Risk Factors

• History of valvular heart disease: These patients are at risk of endocarditis from bacteremia and may require admission for monitoring and IV antibiotics 1
• History of rheumatic fever: Risk of recurrence with untreated streptococcal infection may necessitate admission to ensure adequate treatment 1

Demographic Risk Factors

• Male patients aged 21-40 years who smoke are at significantly higher risk of peritonsillar abscess and may require admission 1

Clinical Assessment Algorithm

When evaluating a patient with sore throat, systematically assess for the following:

Red Flag Symptoms (Require Immediate Action)

1. Airway symptoms: Drooling, stridor, severe dysphagia, respiratory distress 1
2. Sepsis indicators: Hypotension, tachycardia, altered mental status, rigors 1, 3
3. Deep space infection signs: Severe unilateral pain, trismus, neck swelling/tenderness, "hot potato voice" 1
4. Inability to maintain oral intake 1

Special Diagnostic Considerations

For suspected Lemierre syndrome: Notify the laboratory immediately, as Fusobacterium necrophorum requires special anaerobic culture techniques not routinely used for throat specimens 1. Do not delay antibiotic therapy while awaiting culture results when clinical suspicion is high 1. Standard 10-day pharyngitis treatment is inadequate—prolonged therapy is required 1.

Common Pitfalls to Avoid

• Do not dismiss severe unilateral throat pain in young adults as simple pharyngitis—this may represent peritonsillar abscess or early Lemierre syndrome 1, 3
• Do not rely solely on fever presence—immunocompromised patients may not mount febrile responses despite serious infection 1
• Do not assume viral etiology based on age alone—while most sore throats are viral 4, 5, serious bacterial complications can occur at any age 3
• Do not discharge patients with persistent neck pain/swelling without imaging—this may represent deep space infection or Lemierre syndrome 1

Outpatient Management Criteria

Patients can be safely managed outpatient if they meet ALL of the following:

• No airway compromise or respiratory distress 1
• Able to maintain oral hydration 1
• No signs of deep space infection or sepsis 1
• Not in a high-risk population requiring lower admission threshold 1
• Reliable follow-up available within 24-48 hours 5, 6