How is Total Body Surface Area determined in burn patients. What are the primary methods used to calculate TBSA. Why is accurate TBSA assessment critical for burn treatment and prognosis. Which TBSA calculation method is considered most precise for burn injuries. How do newer technologies improve TBSA assessment accuracy.

Understanding Total Body Surface Area (TBSA) in Burn Assessment

Total Body Surface Area (TBSA) is a crucial metric used by medical professionals to evaluate the severity of burn injuries. This assessment tool plays a pivotal role in determining the appropriate course of treatment, fluid resuscitation requirements, and overall prognosis for burn patients. Accurate TBSA calculation is essential for making informed decisions about patient care, including whether transfer to a specialized burn center is necessary.

TBSA assessment involves estimating the percentage of a patient’s body that has been affected by burns. This information guides healthcare providers in developing a tailored treatment plan and helps predict potential complications. The importance of TBSA calculation cannot be overstated, as burns covering more than 30% of the body can be life-threatening.

Why is TBSA Assessment Critical?

• Guides fluid resuscitation protocols
• Informs transfer decisions to specialized burn units
• Aids in determining appropriate pain management strategies
• Helps predict potential complications and long-term outcomes
• Facilitates research and data collection in burn care

Primary Methods for Calculating Total Body Surface Area

Medical professionals employ three primary methods to assess TBSA in burn patients. Each approach has its own strengths and limitations, making them suitable for different scenarios in burn care.

1. Lund and Browder Chart

The Lund and Browder (LB) chart is widely regarded as the most accurate method for TBSA assessment. This technique 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 staff examine the burn injury and sum up the percentages of affected body regions to calculate the total TBSA. While this method offers precision, it requires quick mental calculations and may lead to slight variations between assessors.

2. Wallace Rule of Nines

The Wallace Rule of Nines is a simplified approach primarily used for second- and third-degree burns. This method divides the body into sections, each representing a multiple of 9% of the total body surface area.

What are the body section percentages in the Rule of Nines?

• Each arm: 9%
• Each leg: 18%
• Front torso: 18%
• Back torso: 18%
• Head: 9%
• Groin: 1%

The Wallace Rule of Nines allows for rapid assessment in emergency situations, enabling quick communication of burn extent to the medical team. Its simplicity makes it particularly useful for initial fluid resuscitation calculations.

3. Palmer Method

The Palmer Method uses the patient’s palm as a reference measurement for burn size estimation. In this approach, the area from the wrist to fingertips (with fingers together) is considered to represent approximately 1% of the total body surface area.

While the Palmer Method offers quick estimation, especially for smaller burns, it has limitations in accuracy. Research has shown that an adult’s palm actually represents about 0.78% of their TBSA, while in children, it can be more than 1%. This discrepancy can lead to overestimations of 10-20% in TBSA calculations.

Advancements in TBSA Assessment Technology

The field of burn assessment is evolving with the integration of advanced technologies. 3D modeling and digital applications are revolutionizing the way medical professionals calculate TBSA, offering improved accuracy and consistency in measurements.

3D Technology in Burn Assessment

How are 3D models enhancing TBSA calculations? Advanced software now allows medical teams to utilize 3D representations of human anatomy on desktop and mobile devices. These tools provide a more precise and standardized approach to burn area estimation, reducing the potential for human error and inconsistencies between different assessors.

While the implementation of 3D technology in TBSA assessment is still ongoing in many healthcare facilities, it represents a significant step forward in burn care accuracy and efficiency.

Importance of Accurate TBSA Assessment in Burn Treatment

The precision of TBSA calculation has far-reaching implications for burn patient care. Accurate assessment influences various aspects of treatment, from the immediate emergency response to long-term rehabilitation planning.

Impact on Fluid Resuscitation

How does TBSA affect fluid management in burn patients? The extent of burns directly correlates with the amount of fluid loss a patient experiences. Accurate TBSA calculation is crucial for determining the appropriate volume and rate of fluid replacement, preventing complications such as hypovolemic shock or fluid overload.

Influence on Treatment Decisions

TBSA assessment plays a vital role in determining the level of care a burn patient requires. It helps medical professionals decide whether a patient needs to be transferred to a specialized burn unit or can be managed in a general hospital setting. For burns covering more than 20% TBSA in adults or 10% in children, treatment in a dedicated burn center is often recommended.

Challenges and Limitations in TBSA Calculation

While TBSA assessment methods have improved over time, they still face certain challenges and limitations that healthcare providers must consider.

Variability Between Assessors

One of the primary challenges in TBSA calculation is the potential for variability between different assessors. Factors such as experience level, time pressure in emergency situations, and individual interpretation of burn depth can lead to discrepancies in TBSA estimates.

Accuracy in Special Populations

Standard TBSA calculation methods may not be as accurate for certain patient groups, such as obese individuals or children. In these cases, adjustments to the assessment techniques may be necessary to ensure appropriate treatment planning.

The Role of TBSA in Burn Research and Data Collection

Beyond its immediate clinical applications, TBSA assessment plays a crucial role in burn care research and data collection. Accurate and consistent TBSA calculations enable researchers to compare treatment outcomes, develop new protocols, and improve overall burn care strategies.

Standardization in Burn Studies

How does TBSA contribute to burn research? Standardized TBSA assessment methods allow for meaningful comparisons between different studies and treatment centers. This standardization is essential for advancing our understanding of burn pathophysiology, treatment efficacy, and long-term outcomes.

Quality Improvement Initiatives

Accurate TBSA data collection supports quality improvement efforts in burn care. By analyzing trends in TBSA assessments and corresponding treatment outcomes, healthcare institutions can identify areas for improvement in their burn care protocols and implement evidence-based changes.

Patient Education and TBSA Understanding

While TBSA calculation is primarily a tool for healthcare providers, patient education about this concept can be beneficial for burn survivors and their families. Understanding TBSA can help patients comprehend the extent of their injuries and the rationale behind their treatment plans.

Empowering Patients Through Knowledge

How can understanding TBSA benefit burn patients? By grasping the basics of TBSA assessment, patients can:

• Better understand their prognosis and expected recovery timeline
• Appreciate the importance of following fluid intake recommendations
• Engage more effectively in discussions about their care with medical professionals
• Have realistic expectations about potential scarring and rehabilitation needs

Healthcare providers should strive to explain TBSA concepts in accessible terms, empowering patients to be active participants in their recovery journey.

Future Directions in TBSA Assessment and Burn Care

The field of burn assessment and care continues to evolve, with ongoing research and technological advancements paving the way for more precise and personalized approaches to TBSA calculation and treatment planning.

Artificial Intelligence in Burn Assessment

How might AI transform TBSA calculation? Researchers are exploring the potential of artificial intelligence and machine learning algorithms to analyze burn injuries from digital images. These technologies could provide rapid, objective TBSA assessments, reducing human error and improving consistency across different healthcare settings.

Personalized Burn Care Models

Future developments in burn care may integrate more personalized approaches to TBSA assessment and treatment planning. By considering factors such as a patient’s age, body composition, and overall health status, healthcare providers may be able to tailor TBSA calculations and subsequent treatment protocols more precisely to individual needs.

As research in burn care progresses, we can anticipate further refinements in TBSA assessment methods, leading to improved outcomes for burn survivors worldwide. The ongoing collaboration between clinicians, researchers, and technology experts promises to enhance the accuracy and efficiency of burn assessment, ultimately benefiting patients throughout their recovery journey.

In conclusion, Total Body Surface Area assessment remains a cornerstone of effective burn care. From the traditional methods like the Lund and Browder chart to emerging technologies utilizing 3D modeling and AI, the pursuit of accurate TBSA calculation continues to drive advancements in burn treatment. As we look to the future, the integration of more precise and personalized approaches to TBSA assessment will undoubtedly contribute to better outcomes and quality of life for burn survivors.

Defining Total Body Surface Area (TBSA)

Article

Written on April 19, 2022

Accessibility

Burn Treatment

Burn Wounds

Getting Quality Treatment

Optimal Burn Care

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 Calculator

The calculator below computes the total surface area of a human body, referred to as body surface area (BSA). Direct measurement of BSA is difficult, and as such many formulas have been published that estimate BSA. The calculator below provides results for some of the most popular formulas.

RelatedArea Calculator | Surface Area Calculator

Table of average BSAs

BSA is often used in clinical purposes over body weight because it is a more accurate indicator of metabolic mass (the body’s need for energy). Metabolic mass can be estimated using fat-free mass, where fat-free mass is all of a person’s body mass that does not include fat. This includes bones, tendons, inner organs, muscles, blood, nerves, and more. Since body fat is not metabolically active and fat-free mass excludes body fat, fat-free mass is a reasonable estimate of metabolic mass.

BSA is also used in various other clinical settings, such as determining cardiac index (to relate a person’s heart performance to their body size) or most commonly, dosages for chemotherapy (a category of cancer treatment). While dosing for chemotherapy is often determined using a patient’s BSA, there exist arguments against the use of BSA to determine medication dosages that have a narrow therapeutic index – the comparison of the amount of a substance necessary to produce a therapeutic effect, to the amount that causes toxicity. If the therapeutic index is too narrow, BSA may not be an accurate enough measure, and there is a risk of causing a toxic rather than therapeutic effect. There is also evidence that BSA becomes less accurate at the extremes of height and weight, and BMI may be a better estimate in such cases. Despite these limitations, the effects of chemotherapy dosages as determined by BSA measurements still remain more consistent than those determined by body weight alone.

Below are some of the most popular formulas for estimating BSA, and links to references for each for further detail on their derivations. The most widely used of these is the Du Bois formula, which has been shown to be effective for estimating body fat in both obese and non-obese patients, unlike body mass index. Where BSA is represented in m², W is weight in kg, and H is height in cm, the formulas are as follows:

Du Bois formula:

BSA = 0.007184 × W^0.425 × H^0.725

Du Bois D, Du Bois EF (Jun 1916). “A formula to estimate the approximate surface area if height and weight be known”. Archives of Internal Medicine 17 (6): 863-71. PMID 2520314. Retrieved 2012-09-09.

Mosteller formula:

BSA = = 0.016667 × W^0.5 × H^0.5

Mosteller RD. “Simplified calculation of body-surface area”. N Engl J Med 1987; 317:1098. PMID 3657876.

Haycock formula:

BSA = 0. 024265 × W^0.5378 × H^0.3964

Haycock GB, Schwartz GJ, Wisotsky DH “Geometric method for measuring body surface area: A height-weight formula validated in infants, children and adults” J Pediatr 1978, 93:62-66.

Gehan and George formula:

BSA = 0.0235 × W^0.51456 × H^0.42246

Gehan EA, George SL, Cancer Chemother Rep 1970, 54:225-235

Boyd formula:

BSA = 0.03330 × W^{(0.6157 – 0.0188 × log10(W)} × H^0.3

Boyd, Edith (1935). The Growth of the Surface Area of the Human Body. University of Minnesota. The Institute of Child Welfare, Monograph Series, No. x. London: Oxford University Press

Fujimoto formula:

BSA = 0.008883 × W^0.444 × H^0.663

Fujimoto S, Watanabe T, Sakamoto A, Yukawa K, Morimoto K. Studies on the physical surface area of Japanese. 18. Calculation formulae in three stages over all ages. Nippon Eiseigaku Zasshi 1968;5:443-50.

Takahira formula:

BSA = 0. 007241 × W^0.425 × H^0.725

Fujimoto S, Watanabe T, Sakamoto A, Yukawa K, Morimoto K. Studies on the physical surface area of Japanese. 18. Calculation formulae in three stages over all ages. Nippon Eiseigaku Zasshi 1968;5:443-50.

Schlich formula:

Women BSA = 0.000975482 × W^0.46 × H^1.08

Men BSA = 0.000579479 × W^0.38 × H^1.24

Schlich E, Schumm M, Schlich M: “3-D-Body-Scan als anthropometrisches Verfahren zur Bestimmung der spezifischen Korperoberflache”. Ernahrungs Umschau 2010;57:178-183

Calculation of the surface area of ​​complex parts

Author :

Danilko Vladimir Andreevich

Supervisor :

Kostrova Yulia Sergeevna

Category : Mathematics

Posted by
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young scientist

#16 (411) April 2022

Publication date : 19. 04.2022
2022-04-19

Article viewed:

734 times

Download electronic version

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References:

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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