How is Total Body Surface Area determined in burn patients. What are the main methods used to calculate TBSA. Why is accurate TBSA assessment critical for burn treatment and prognosis. How do different TBSA calculation methods compare in accuracy and ease of use.

Understanding Total Body Surface Area (TBSA) in Burn Assessment

Total Body Surface Area (TBSA) is a crucial concept in the field of burn treatment and management. It refers to the percentage of a person’s body that has been affected by burns. Accurate TBSA assessment is vital for determining the severity of burns, guiding treatment decisions, and predicting patient outcomes.

TBSA calculation plays a pivotal role in various aspects of burn care, including:

• Fluid resuscitation requirements
• Transfer decisions to specialized burn units
• Overall management strategies
• Prognosis determination
• Research and data collection

Given its significance, healthcare professionals must be well-versed in the methods used to calculate TBSA quickly and accurately. Let’s explore the primary techniques employed in clinical settings.

The Lund and Browder Chart: Precision in TBSA Calculation

The Lund and Browder (LB) chart is widely regarded as the most accurate method for assessing TBSA in burn patients. This technique utilizes detailed diagrams of the human body, both anterior and posterior views, with assigned percentages for different body regions.

Key Features of the Lund and Browder Chart

• Body regions are assigned percentages ranging from 1% to 13%
• Provides separate charts for adults and children, accounting for age-related differences in body proportions
• Allows for precise calculation by adding up percentages of affected areas

Why is the Lund and Browder chart considered the gold standard for TBSA assessment? The LB chart’s accuracy stems from its detailed breakdown of body regions and age-specific adjustments. This level of precision is particularly crucial for pediatric patients, whose body proportions differ significantly from adults.

Despite its accuracy, 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 between assessors, emphasizing the need for standardized training and practice.

The Wallace Rule of Nines: Simplicity in Burn Assessment

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

Breakdown of the Rule of Nines for Adults

• Head and neck: 9%
• Each arm: 9%
• Chest: 18%
• Back: 18%
• Each leg: 18%
• Genitals/perineum: 1%

Why is the Rule of Nines popular in emergency settings? The simplicity of this method allows for rapid assessment, which is crucial in time-sensitive situations. It provides a quick estimate that can guide immediate treatment decisions, particularly regarding fluid resuscitation.

However, it’s important to note that the Rule of Nines is less accurate than the Lund and Browder chart, especially for children and individuals with non-standard body proportions. In these cases, modifications to the percentages may be necessary for a more accurate assessment.

The Palmer Method: Hand-Based TBSA Estimation

The Palmer Method offers a unique approach to TBSA calculation by using the patient’s own hand as a reference point. This technique is particularly useful for assessing smaller burns or when other methods are not readily available.

Key Principles of the Palmer Method

• The patient’s palm (including fingers) represents approximately 1% of their total body surface area
• Burn size is estimated by comparing it to the number of “palm-sized” areas affected
• Quick and easy to perform without specialized tools or charts

What are the advantages of using the Palmer Method? This technique is highly portable and can be used in various settings without the need for charts or diagrams. It’s particularly useful for smaller burns where precise measurement is less critical.

However, the Palmer Method has limitations in accuracy. Research has shown that an adult’s palm actually represents closer to 0.78% of their TBSA, while in children it can be over 1%. This discrepancy can lead to overestimation of burn size by 10-20%, particularly in larger burns. Therefore, the Palmer Method is best reserved for initial estimates of small burns rather than comprehensive assessments of severe injuries.

Comparing TBSA Assessment Methods: Accuracy vs. Practicality

When it comes to TBSA assessment, healthcare providers must balance accuracy with practicality. Each method has its strengths and weaknesses, making them suitable for different scenarios.

Accuracy Comparison

1. Lund and Browder Chart: Most accurate, especially for varied age groups
2. Wallace Rule of Nines: Moderately accurate for adults, less so for children
3. Palmer Method: Least accurate, prone to overestimation

Practicality Comparison

1. Palmer Method: Most practical, requires no tools
2. Wallace Rule of Nines: Fairly practical, easy to remember
3. Lund and Browder Chart: Least practical, requires charts and calculations

Which method should be used in different clinical scenarios? In emergency settings where rapid assessment is crucial, the Rule of Nines or Palmer Method may be preferred for their speed and simplicity. However, for definitive assessment and treatment planning, the Lund and Browder chart should be used whenever possible due to its superior accuracy.

The Impact of TBSA Assessment on Burn Treatment and Prognosis

Accurate TBSA assessment is not just an academic exercise; it has significant implications for patient care and outcomes. The percentage of TBSA affected by burns directly influences several critical aspects of burn management.

Key Areas Influenced by TBSA Assessment

• Fluid Resuscitation: TBSA determines the volume of fluids needed to prevent shock
• Nutritional Requirements: Larger TBSA burns increase metabolic demands
• Wound Care Strategies: Extent of burns guides dressing choices and frequency
• Surgical Interventions: TBSA helps determine the need for and timing of skin grafts
• Mortality Risk: Burns covering more than 30% TBSA significantly increase mortality risk

How does TBSA assessment impact long-term prognosis? Patients with larger TBSA burns typically face longer hospital stays, increased risk of complications, and more extensive rehabilitation needs. Accurate initial assessment helps in setting realistic expectations and planning comprehensive care strategies.

Advancements in TBSA Assessment: The Role of Technology

While traditional methods of TBSA assessment remain widely used, technological advancements are beginning to reshape this critical aspect of burn care. Digital solutions offer the potential for increased accuracy and consistency in burn size estimation.

Emerging Technologies in TBSA Assessment

• 3D Scanning: Captures precise body measurements for accurate TBSA calculation
• Mobile Applications: Provide digital versions of assessment tools for easy reference
• Artificial Intelligence: Assists in analyzing burn images for consistent TBSA estimation
• Virtual Reality: Offers training simulations for healthcare providers to improve assessment skills

How are these technologies improving TBSA assessment? Digital tools can reduce human error, provide more objective measurements, and allow for better documentation and tracking of burn progression over time. They also facilitate easier sharing of information between healthcare providers, improving continuity of care.

While promising, it’s important to note that many of these technologies are still in the development or early implementation stages. Their full integration into clinical practice will require further validation, standardization, and training for healthcare providers.

Beyond TBSA: Holistic Approaches to Burn Assessment and Care

While TBSA is a crucial metric in burn care, it’s essential to remember that it’s just one piece of the puzzle. A comprehensive approach to burn assessment and treatment considers multiple factors beyond surface area alone.

Additional Factors in Burn Assessment

• Burn Depth: Superficial, partial-thickness, or full-thickness burns
• Location: Burns on functional areas (e.g., hands, face) may require specialized care
• Patient Age and Overall Health: Influences healing capacity and treatment approach
• Inhalation Injuries: Can significantly impact prognosis, independent of TBSA
• Associated Trauma: Other injuries may complicate burn treatment

How do these factors interact with TBSA in guiding treatment decisions? A smaller TBSA burn on a critical area like the face may require more intensive treatment than a larger TBSA burn on the back. Similarly, inhalation injuries can dramatically worsen outcomes even in burns with relatively low TBSA.

Burn care professionals must consider all these factors in conjunction with TBSA to develop a comprehensive treatment plan. This holistic approach ensures that each patient receives personalized care tailored to their specific injuries and circumstances.

Understanding TBSA and its assessment methods is crucial for both healthcare providers and patients navigating the complex world of burn care. As techniques continue to evolve and improve, the goal remains constant: to provide the most accurate, efficient, and effective care possible for individuals suffering from burn injuries.

For burn survivors and their families, knowledge of TBSA and its implications can empower them to actively participate in their care and recovery process. Organizations like the Phoenix Society offer valuable resources and support for those on the journey of burn recovery, helping to bridge the gap between medical treatment and long-term healing.

As research progresses and technology advances, we can look forward to even more precise and personalized approaches to burn assessment and care. These developments promise to improve outcomes and quality of life for burn survivors around the world.

Defining Total Body Surface Area (TBSA)

Article

Written on April 19, 2022

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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. 

Estimating body surface area – WikEM

Contents

• 1 Rule of Nines
• 2 Rule of Palms
• 3 Lund-Browder Classification
• 4 See Also
• 5 References

Rule of Nines

Rule of Nines

Children

Anatomic structure	Surface area
Anterior Head	9%
Posterior Head	9%
Anterior Torso	18%
Posterior Torso	18%
Each Anterior Leg	6. 5%
Each Posterior Leg	6.5%
Each Anterior Arm	4.5%
Each Posterior Arm	4.5%
Genitalia/Perineum	1%

Rule of Palms

• Patient’s entire hand (palm+fingers) = about 1% TBSA
• Use to estimate scatter burns
• Also use for local burns up to 10% BSA

Lund-Browder Classification

Lund Browder Chart to document initial TBSA assessment.

An alternative method of estimate burn surface area

• More accurate than “Rule of Nines,” especially in pediatric patients

Children

Anatomic structure	0 Yr	1 Yr	5 Yrs	10 Yrs	15 Yrs
Anterior Head	9.5%	8.5%	6.5%	5.5%	4.5%
Posterior Head	9.5%	8.5%	6.5%	5. 5%	4.5%
Anterior Neck	1%	1%	1%	1%	1%
Posterior Neck	1%	1%	1%	1%	1%
Anterior Torso	13%	13%	13%	13%	13%
Posterior Torso	13%	13%	13%	13%	13%
Each Anterior Upper Leg	2.75%	3.25%	4%	4.25%	4.5%
Each Posterior Upper Leg	2.75%	3.25%	4%	4.25%	4.5%
Each Anterior Lower Leg	2.5%	2.5%	2.75%	3%	3.25%
Each Posterior Lower Leg	2.5%	2.5%	2.75%	3%	3.25%
Each Anterior Upper Arm	2%	2%	2%	2%	2%
Each Posterior Upper Arm	2%	2%	2%	2%	2%
Each Anterior Lower Arm	1. 5%	1.5%	1.5%	1.5%	1.5%
Each Posterior Lower Arm	1.5%	1.5%	1.5%	1.5%	1.5%
Each Anterior Hand	1.5%	1.5%	1.5%	1.5%	1.5%
Each Posterior Hand	1.5%	1.5%	1.5%	1.5%	1.5%
Each Anterior Foot/Ankle	1.75%	1.75%	1.75%	1.75%	1.75%
Each Posterior Foot/Ankle	1.75%	1.75%	1.75%	1.75%	1.75%
Each Buttock	2.5%	2.5%	2.5%	2.5%	2.5%
Genitalia/Perineum	1%	1%	1%	1%	1%

See Also

• Burns

References

Authors:

• Ross Donaldson
• Jaskaran Singh
• Claire
• Jonathon Keast

Calculation of the surface area of ​​complex parts

Author :

Danilko Vladimir Andreevich

Supervisor :

Kostrova Yulia Sergeevna

Category : Mathematics

Posted by
V

young scientist

#16 (411) April 2022

Publication date : 19. 04.2022
2022-04-19

Article viewed:

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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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