What is Total Body Surface Area (TBSA). How is TBSA calculated. Why is TBSA important in burn assessment. What are the main methods for determining TBSA. How accurate are different TBSA calculation methods. What are the advantages and limitations of each TBSA assessment technique. How is TBSA used in medical treatment and research.

Understanding Total Body Surface Area (TBSA): A Critical Tool in Burn Assessment

Total Body Surface Area (TBSA) is a fundamental concept in burn care and treatment. It serves as a crucial metric for medical professionals to evaluate the severity of burn injuries and guide subsequent treatment decisions. TBSA calculations play a vital role in determining fluid resuscitation requirements, transfer decisions, management strategies, prognosis, and research protocols.

Why is TBSA so important in burn assessment? The extent of a burn injury, expressed as a percentage of the total body surface area, directly correlates with the severity of the patient’s condition and the potential for complications. Accurate TBSA calculations are essential for:

• Determining the need for specialized burn center care
• Calculating fluid resuscitation volumes
• Assessing the risk of systemic complications
• Guiding nutritional support
• Estimating prognosis and recovery time

Given the critical nature of TBSA in burn management, it’s crucial for healthcare providers to utilize accurate and efficient methods for its calculation. Let’s explore the primary techniques used to determine TBSA in clinical settings.

The Lund and Browder Chart: Precision in TBSA Calculation

Among the various methods used to assess TBSA, the Lund and Browder (LB) chart is widely regarded as the most accurate. This method utilizes detailed diagrams of the human body, both anterior and posterior views, with assigned percentages for different body regions ranging from 1% to 13%.

How does the Lund and Browder chart work?

Medical professionals examine the burn injury and add up the percentages of each affected body region to calculate the total TBSA. This method takes into account age-related variations in body proportions, making it particularly useful for assessing burns in children.

What are the advantages of the Lund and Browder chart?

• High accuracy in TBSA estimation
• Accounts for age-related differences in body proportions
• Provides a comprehensive visual representation of burn distribution

Despite its precision, the LB chart does have some limitations. It requires quick mental calculations, which can be challenging in high-stress emergency situations. Additionally, there may be some variability in TBSA calculations between different medical staff members, highlighting the importance of standardized training and consistent application of the method.

The Wallace Rule of Nines: Simplifying TBSA Estimation

The Wallace Rule of Nines offers a straightforward approach to TBSA calculation, particularly useful for second- and third-degree burn injuries. This method assigns percentages to body regions in multiples of nine, making it easy to perform quick mental calculations.

How is the Rule of Nines applied?

In adults, the body is divided into eleven areas, each representing 9% of the total body surface area (except for the perineum, which is assigned 1%). Here’s a breakdown of the percentage assignments:

• Head and neck: 9%
• Each arm: 9% (18% total for both arms)
• Chest: 9%
• Abdomen: 9%
• Upper back: 9%
• Lower back: 9%
• Each leg: 18% (36% total for both legs)
• Perineum: 1%

What are the benefits of using the Wallace Rule of Nines?

• Quick and easy to perform in emergency situations
• Facilitates rapid communication of burn extent among medical team members
• Enables swift decision-making for initial treatment and transfer

It’s important to note that while the Rule of Nines is efficient, it may be less accurate than the Lund and Browder chart, especially for partial-thickness burns or in pediatric patients where body proportions differ significantly from adults.

The Palmer Method: A Handy Approach to TBSA Estimation

The Palmer Method offers yet another technique for estimating TBSA, particularly useful for smaller burns. This approach uses the patient’s own palm as a reference measurement, with the area from the wrist to the tip of the fingers representing approximately 1% of the total body surface area.

How is the Palmer Method implemented?

Medical professionals use the patient’s palm (with fingers together) as a unit of measurement, comparing it to the burned areas to estimate the percentage of TBSA affected. This method is particularly useful for scattered or irregularly shaped burns.

What are the advantages and limitations of the Palmer Method?

• Advantages:
  • Quick and easy to use, especially for small burns
  • Requires no special equipment or charts
  • Useful for estimating burn size in field or pre-hospital settings
• Limitations:
  • Less accurate than other methods, especially for larger burns
  • Can lead to overestimation of burn size by 10-20%
  • Variations in hand size relative to body surface area can affect accuracy

It’s crucial to remember that the Palmer Method provides only a rough initial estimate and is best suited for small burns or as a quick reference in the field. More accurate methods should be employed for definitive TBSA calculations in clinical settings.

Comparing TBSA Calculation Methods: Accuracy vs. Practicality

When it comes to TBSA calculation, medical professionals must balance the need for accuracy with the practicality of application in various clinical scenarios. Each method has its strengths and weaknesses, and understanding these can help in choosing the most appropriate technique for a given situation.

How do the different TBSA calculation methods compare?

Which method should be used in different clinical scenarios?

• Emergency situations: Wallace Rule of Nines or Palmer Method for quick initial assessments
• Pediatric burns: Lund and Browder Chart for age-adjusted accuracy
• Comprehensive burn unit evaluations: Lund and Browder Chart for detailed documentation
• Small or scattered burns: Palmer Method for rapid estimation

It’s important to note that regardless of the method used, TBSA calculations should be performed by trained medical professionals and verified when possible. In many cases, a combination of methods may be employed to ensure the most accurate assessment.

Advancements in TBSA Assessment: The Role of Technology

As medical technology continues to evolve, new tools and techniques are emerging to enhance the accuracy and efficiency of TBSA calculations. These advancements aim to address the limitations of traditional methods and provide more precise burn assessments.

How is technology improving TBSA assessment?

Recent developments in digital health and imaging technologies are revolutionizing the way TBSA is calculated. Some notable advancements include:

• 3D scanning and modeling: Portable 3D scanners can create accurate digital models of a patient’s body, allowing for precise TBSA calculations.
• Mobile applications: Smartphone apps utilizing augmented reality (AR) can assist in TBSA estimation by overlaying measurement tools on live camera views.
• Artificial Intelligence (AI): Machine learning algorithms can analyze digital images of burns to provide rapid and accurate TBSA calculations.
• Computerized planimetry: Digital mapping of burn areas on standardized body diagrams for more precise measurements.

What are the potential benefits of these technological advancements?

• Increased accuracy in TBSA calculations
• Reduced inter-observer variability
• Faster assessment times, especially for complex burn patterns
• Improved documentation and tracking of burn progression over time
• Enhanced communication between healthcare providers through standardized digital formats

While these technologies show great promise, it’s important to note that they are still in various stages of development and implementation. Many hospitals and burn centers are in the process of integrating these tools into their clinical workflows, and further research is needed to validate their effectiveness compared to traditional methods.

The Impact of Accurate TBSA Assessment on Burn Treatment and Outcomes

The importance of precise TBSA calculation extends far beyond initial burn assessment. Accurate TBSA measurements have a profound impact on various aspects of burn care, from immediate treatment decisions to long-term recovery planning.

How does TBSA influence burn treatment protocols?

TBSA calculations play a crucial role in several key areas of burn management:

• Fluid resuscitation: The Parkland Formula, widely used for calculating fluid requirements in burn patients, relies heavily on accurate TBSA measurements.
• Nutritional support: TBSA is a key factor in determining the increased caloric needs of burn patients.
• Wound management: The extent of TBSA affected influences decisions about topical treatments, dressing changes, and potential surgical interventions.
• Infection risk assessment: Larger TBSA burns are associated with higher risks of infection, guiding antibiotic prophylaxis strategies.
• Rehabilitation planning: TBSA affects the duration and intensity of physical therapy and rehabilitation programs.

What are the potential consequences of inaccurate TBSA calculations?

• Overestimation of TBSA can lead to:
  • Excessive fluid administration, potentially causing pulmonary edema or compartment syndrome
  • Unnecessary transfers to specialized burn centers
  • Overestimation of nutritional requirements
• Underestimation of TBSA can result in:
  • Inadequate fluid resuscitation, leading to hypovolemic shock
  • Delayed transfer to appropriate care facilities
  • Insufficient nutritional support

Given these potential consequences, it’s clear that accurate TBSA assessment is not just a matter of academic interest but a critical factor in ensuring optimal patient outcomes. Continuous training and standardization of TBSA calculation methods among healthcare providers are essential to maintain high standards of burn care.

Beyond TBSA: Holistic Approaches to Burn Care and Recovery

While TBSA is a crucial metric in burn assessment and treatment, it’s important to recognize that burn care extends far beyond numerical calculations. A holistic approach to burn treatment and recovery encompasses physical, psychological, and social aspects of patient care.

What components are essential for comprehensive burn care?

A well-rounded burn care program should include:

• Acute medical management: Fluid resuscitation, wound care, pain management, and infection control
• Surgical interventions: Debridement, skin grafting, and reconstructive procedures as needed
• Rehabilitation: Physical and occupational therapy to restore function and prevent complications
• Psychological support: Counseling and therapy to address trauma, body image issues, and adjustment challenges
• Nutritional care: Specialized diets to support wound healing and overall recovery
• Scar management: Treatments to minimize scarring and improve aesthetic outcomes
• Patient education: Empowering patients with knowledge about their condition and recovery process
• Social support: Connecting patients with support groups and resources for long-term recovery

How can burn survivors and their families access additional support and resources?

Organizations like the Phoenix Society for Burn Survivors offer valuable resources and support networks for individuals recovering from burn injuries. These resources may include:

• Educational materials on burn recovery and rehabilitation
• Peer support programs connecting burn survivors
• Online forums and support groups
• Information on adaptive technologies and assistive devices
• Guidance on returning to work or school after a burn injury
• Resources for addressing the psychosocial aspects of burn recovery

By combining accurate medical assessment techniques like TBSA calculation with comprehensive care approaches and support systems, healthcare providers can offer burn survivors the best possible chance for recovery and reintegration into their communities.

As research in burn care continues to advance, we can expect further refinements in TBSA assessment methods and treatment protocols. The integration of technology, coupled with a deeper understanding of the physiological and psychological aspects of burn recovery, promises to improve outcomes for burn survivors in the years to come.

Defining Total Body Surface Area (TBSA)

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Written on April 19, 2022

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Burn Treatment

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One of the most common phrases you’re likely to come across throughout the burn treatment process is total body surface area (TBSA). TBSA is a tool medical professionals use to assess the severity of a patient’s burns. The speed and accuracy of this initial assessment is critical because it informs all steps of the patient healthcare journey, including fluid resuscitation, transfer decisions, management, prognosis, and research.

There are three primary methods of calculation. Each has its own grading system, use case, and pros and cons. In this article, we’ll take a closer look at these three methods of assessing TBSA. Equip yourself with the knowledge you need to understand and ask questions about your treatment and recovery.

How Is the Total Body Surface Area Determined?

To calculate TBSA, doctors and nurse practitioners focus on three main methods: Lund and Browder, Wallace Rule of Nines, and the Palmer Method.  

Lund and Browder Chart

The first method of burn assessment uses the Lund and Browder (LB) chart. The LB chart shows both anterior and posterior diagrams of the human body and assigns percentages to each region of the body, from 1-13 percent. As medical staff members examine the burn injury, they add up the percentages of each body region to calculate the severity of all injuries. 

Lund and Browder is considered the most accurate of these three methods, but the LB chart still has its limitations. This method requires quick mental calculation. Ease of use is also a concern as medical staff members may come up with different TBSA calculations. This is why it’s so important that TBSA formulas are precise, reliable, and repeatable. 

Wallace Rule of Nines

The Wallace Rule of Nines is most often used for second- and third-degree burn injuries. Every burned portion of the body is counted by a multiple of nine. Each arm, for example, is assigned 9 percent; each leg is assigned 18 percent. A doctor or nurse practitioner can quickly add up the total body surface burned based on an initial visual examination. The table below from Healthline shows the Rule of Nines percentage points for adults: 

The advantage of using the Wallace Rule of Nines is that the estimation is a simple formula, and, therefore, it is easy to calculate the amount of fluid replacement (IVs) and level of care a patient will require. It offers quick assessments in emergency situations and empowers medical professionals to quickly relay burn injury measurements to the rest of the team. Because burn injuries with a percentage of 30-plus percent can be fatal, a quick response is critical. 

Palmer Method

The third method is known as the Palmer Method. Medical staff use the length of the patient’s palm (fingers together), not their own, as a reference measurement for calculating burn size and span. The length from wrist to finger = 1 percent TBSA. 

On one hand, the Palmer Method makes it easy to calculate quickly and assess a patient’s fluid resuscitation and care needs. On the other hand, the Palmer Method is far from perfect science. In fact, the average adult’s hand makes up 0.78 percent of their total body surface area. In most children, that same number is more than 1 percent. For this reason, the Palmer Method can lead to burn injury overestimations of anywhere from 10-20 percent. It’s important to remember that the Palmer Method is only a rough initial estimate and is best used for small burns. 

Methods of TBSA assessment continue to improve, thanks to 3D technology. Medical teams now have access to 3D models of human anatomy on desktop and mobile applications to quickly and accurately assess burn injuries. Full rollout and implementation is still in the works in hospitals and burn centers throughout the United States.

TBSA is just one of the first steps toward burn diagnostics, treatment, and recovery. Burn survivors can take additional steps on their own toward understanding, acceptance, and community-building as they come to terms with their injury on the road to healing.  

Phoenix Society offers a full library of resources from survivors and medical experts who understand what you’re going through. Looking for added support as you navigate the treatment and recovery process? Reach out today. 

Body Surface Area – StatPearls

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Last Update: March 25, 2023.

Definition/Introduction

Body surface area was developed as a metric to use in the modulation of various pharmacological therapies and a standard tool by which to index various physiologic measurements such as glomerular filtration rate and cardiac output. There exist many variations in formulae to calculate an individual’s body surface area, but one of the most widely used techniques to calculate this value is the Du Bois and Du Bois formula. The formula is as follows[1]:

Issues of Concern

A predominant area of concern in calculating body surface area is that many different equations are used in the calculation. As such, some of the equations may yield vastly different results from others. In the clinical context, this presents a significant challenge. For example, body surface area is used to calculate the dosing regimen for many medications to ensure the medication’s therapeutic window is maintained and adverse effects avoided. Significant variances in body surface area calculations potentially result in over or underdosing of drugs and failure to obtain the targeted effects of the drug.[2]

Clinical Significance

The body surface area metric holds a significant place in both pharmacology and physiologic data measurement. Body surface area is most commonly used to guide the dosing of chemotherapeutic drugs. Early chemotherapy research found that the effects of these cancer treatments were much more consistent among individuals when dosed according to body surface area as opposed to body weight alone. [3] 

Body surface area is also useful to assess the degree of severity in severe burn injury patients. It is crucial to accurately assess the percentage of total body surface area that a patient has sustained burns to stratify the severity best and guide the management of patients with burn injuries.[4] Physiologic information can be calculated in part using body surface area.

Another essential use of body surface area is in calculating a patient’s cardiac index, a measure of the physiologic status of cardiac function. The formula for the cardiac index is (liters/min)/(body surface area).[5] Further, the use of clinical tools, such as nomograms, utilizes the patient’s height and weight displayed graphically to calculate their body surface area as well. 

Nursing, Allied Health, and Interprofessional Team Interventions

Clinical teams managing patients in hospital units or clinics that administer and manage chemotherapy treatment regimens should possess a sound understanding of how to calculate body surface area. It should be a routinely observed metric for any patient under the care of a chemotherapy treatment plan. Furthermore, clinical providers, nursing staff, and allied healthcare workers who work in burn injury units should also develop an understanding of the calculation of body surface area and its implications, specifically in the management of burn injuries.

Nursing, Allied Health, and Interprofessional Team Monitoring

In summary, all staff caring for patients should understand how to calculate the body surface area. In patient populations in which its utility is particularly underscored, this skill is even more vital. Furthermore, physicians, medical students, and nurses need to comprehend the significance of body surface area as it relates to chemotherapy, meter the severity of burn injuries, and understand physiologic parameters.

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References

1.

Burton RF. Estimating body surface area from mass and height: theory and the formula of Du Bois and Du Bois. Ann Hum Biol. 2008 Mar-Apr;35(2):170-84. [PubMed: 18428011]

2.

Sigurdsson TS, Lindberg L. Six commonly used empirical body surface area formulas disagreed in young children undergoing corrective heart surgery. Acta Paediatr. 2020 Sep;109(9):1838-1846. [PubMed: 32010999]

3.

Kaestner SA, Sewell GJ. Chemotherapy dosing part I: scientific basis for current practice and use of body surface area. Clin Oncol (R Coll Radiol). 2007 Feb;19(1):23-37. [PubMed: 17305252]

4.

Retrouvey H, Chan J, Shahrokhi S. Comparison of two-dimensional methods versus three-dimensional scanning systems in the assessment of total body surface area estimation in burn patients. Burns. 2018 Feb;44(1):195-200. [PubMed: 28797577]

5.

Patel N, Durland J, Makaryus AN. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Sep 26, 2022. Physiology, Cardiac Index. [PubMed: 30969727]

Disclosure: Bronson Flint declares no relevant financial relationships with ineligible companies.

Disclosure: Carrie Hall declares no relevant financial relationships with ineligible companies.

Copyright © 2023, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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• Definition/Introduction
• Issues of Concern
• Clinical Significance
• Nursing, Allied Health, and Interprofessional Team Interventions
• Nursing, Allied Health, and Interprofessional Team Monitoring
• Review Questions
• References

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• Estimating body surface area from mass and height: theory and the formula of Du Bois and Du Bois.[Ann Hum Biol. 2008]
• Body surface area: Du Bois and Du Bois revisited.[Eur J Appl Physiol. 2000]
• Review The importance of metabolic rate and the folly of body surface area calculations.[Anaesthesia. 2003]
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Calculation of the surface area of ​​complex parts

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Danilko Vladimir Andreevich

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Kostrova Yulia Sergeevna

Category : Mathematics

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Publication date : 19. 04.2022
2022-04-19

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Danilko, V. A. Calculation of the surface area of ​​complex parts / V. A. Danilko. – Text: direct // Young scientist. – 2022. – No. 16 (411). – P. 4-7. — URL: https://moluch.ru/archive/411/

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