When should I consider referring a patient with suspected osteomyelitis to secondary care for further evaluation?

Consider referring a patient with suspected osteomyelitis to secondary care for further evaluation if:

• They have signs or symptoms suggesting a more serious condition such as osteomyelitis itself, especially if associated with systemic illness or complications.
• They are systemically unwell, frail, immunocompromised, or have comorbidities that may complicate or delay recovery.
• There is severe pain disproportionate to the infection or rapid worsening of symptoms.
• They do not start to improve within 1 to 2 days of initial management or antibiotic treatment.
• Specialist imaging (such as MRI or CT) or tissue sampling is needed to confirm diagnosis or guide treatment.
• They require prolonged intravenous antibiotics or surgical intervention.

Referral is important to enable specialist assessment, imaging, microbiological diagnosis, and management including possible surgical debridement and prolonged antibiotic therapy.

This approach aligns with recommendations for managing diabetic foot infections with osteomyelitis and cellulitis where hospital referral is advised for severe or complicated infections, systemic illness, or failure to respond to initial treatment.