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

Criteria for referral of a patient with a bite wound to secondary care include:

• Presence of significant wound complications such as infection with cellulitis, abscess formation, or devitalised tissue requiring specialist management ¹.
• Wounds that are contaminated, dirty, or infected, especially if treatment has been delayed or there is faecal contamination ¹.
• Wounds that are complex or involve underlying structures such as joints, tendons, or bones, which may require specialist surgical assessment ².
• Wounds that are more than 12 to 24 hours old, as delayed treatment increases risk of infection and may necessitate secondary care ¹.
• Any signs of systemic infection such as fever or raised white blood cell count indicating possible surgical site infection ¹.
• Patients with immunosuppression or comorbidities that impair wound healing or increase infection risk should be considered for referral ¹.

Referral should be prompt to ensure appropriate surgical or specialist wound care, including possible debridement and antibiotic therapy tailored to likely pathogens ¹,².