What criteria should I use to determine whether a patient with an acute wound requires referral to secondary care?

Patients with acute wounds should be referred to secondary care if they exhibit any of the following criteria:

• Presence of wound complications such as infection with systemic signs (e.g., fever, cellulitis) or treatment failure requiring specialist antibiotic management.
• Complex wounds requiring specialist intervention, including those needing debridement not suitable for primary care or wounds healing by secondary intention that require expert tissue viability input.
• Open fractures or wounds associated with complex fractures, especially displaced pilon fractures or intra-articular distal tibia fractures, where definitive management or surgery cannot be performed within 24 hours at the initial hospital.
• Wounds with risk factors for poor healing identified during preoperative assessment or wounds requiring advanced dressing techniques and specialist wound care services.
• Any acute wound with significant tissue damage or contamination that may require orthoplastic or specialist trauma centre care.

Referral should be prompt to ensure timely surgical or specialist management, including transfer to orthoplastic centres when indicated, to optimise outcomes.

In summary, referral to secondary care is indicated for acute wounds with infection, complex tissue damage, associated complex fractures, or when specialist wound care expertise is required beyond primary care capabilities.

NICE NG125,NICE NG37