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Lacerations – Criteria to Inform Referral Needs in Stable Patients

In your stable patients with lacerations, who do not have any urgent or troublesome A-D problems and who have not sustained injury through any great mechanism, what else should you be looking for in your assessment of their injury? What are the risk factors, according to different guidelines or authors?

While some of these elements may not be enough to refer a patient to secondary care on their own, they should help to increase your risk assessment during safe discharges. In combination, many of these factors should raise flags.

DepthSizeRisk FactorsArea
There is limited evidence regarding the depth of wounds. The emphasis is on the structures that deep wounds would impact. For example, vascular damage, and nerve, tendon, or bony injuries (NICE, 2021). More than 5cm (NICE, 2021). Two or more of:
– Malaise
– Fever
– Rigors
– Contamination of site with body fluids, soil, faeces, or/and pus.
– Patient older than 65 years
– Diabetes
– Jagged wound edges
– Signs of tetanus
(NICE, 2021)
Any of:
– Face
– Palm – and there is a potential infection.
– Joint with cellulitis.
(NICE, 2021).
Contamination from unknown object (e.g. knife/glass) (NICE, 2021).
Presence of necrotic tissue or slough, which could delay healing. Granulation tissue can also delay wound healing, but all can be prevented with appropriate dressings (Wilson, 2012: 11).
Wounds older than 24 hours (Newman and Mahdy, 2021).
Bites (Newman and Mahdy, 2021).
Lacerations: A Collection of Risk Factors and Specific Criteria to Inform Referral Needs in Stable Patients.

Have you found more, or would you like to add some from your own experience? Add these in the comments below, and let us know what you think about this post.


Newman, R.K. and Mahdy, H. (2021) ‘Laceration’, Treasure Island. Available at: (Accessed 18/11/2021)

NICE. (2021). Lacerations. Available at: (Accessed 18/11/2021).

Wilson, M. (2012) ‘Understanding the basics of wound assessment’. Wounds Essentials. 2. Pp. 8-12. Available at: (Accessed 28/12/2021).

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