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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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

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

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