Body surface area diagram. Calculating Total Body Surface Area (TBSA): Essential Methods for Burn Assessment

13.07.202214.07.2023 by alexxlab

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 care. How do different TBSA calculation methods compare in accuracy and practicality.

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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 plays a pivotal role in determining the appropriate course of treatment, including fluid resuscitation, transfer decisions, and overall patient management. Accurate TBSA calculation is essential for providing optimal care and improving patient outcomes.

There are three primary methods used to calculate TBSA:

Lund and Browder Chart
Wallace Rule of Nines
Palmer Method

Each of these methods has its own unique approach, advantages, and limitations. Understanding these techniques can help patients and caregivers better comprehend the assessment process and engage more effectively with their healthcare providers.

The Lund and Browder Chart: A Comprehensive Approach to TBSA Calculation

The Lund and Browder (LB) chart is widely regarded as the most accurate method for calculating TBSA. This technique utilizes detailed diagrams of the human body, both anterior and posterior views, with assigned percentages for each body region 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 affected body regions to determine the overall TBSA. This method provides a more nuanced assessment, taking into account variations in body proportions between adults and children.

Advantages of the Lund and Browder Chart

High accuracy in TBSA estimation
Accounts for age-related differences in body proportions
Provides detailed assessment of specific body regions

Limitations of the Lund and Browder Chart

Requires quick mental calculations
May lead to variations in results between different medical staff members
More time-consuming compared to other methods

The Wallace Rule of Nines: A Quick and Efficient TBSA Estimation Method

The Wallace Rule of Nines is a popular method for assessing second- and third-degree burn injuries. This technique divides the body into sections, each representing a multiple of nine percent of the total body surface area.

How is the Wallace Rule of Nines applied?

In adults, the body is divided as follows:

Each arm: 9%
Each leg: 18%
Anterior torso: 18%
Posterior torso: 18%
Head: 9%
Genitalia/perineum: 1%

Medical professionals can quickly sum up the affected areas to determine the total TBSA burned.

Advantages of the Wallace Rule of Nines

Simple and quick to calculate
Ideal for emergency situations requiring rapid assessment
Facilitates easy communication of burn extent among medical team members

Limitations of the Wallace Rule of Nines

Less accurate for children due to different body proportions
May overestimate or underestimate burn size in certain body regions
Not suitable for precise assessment of smaller burns

The Palmer Method: A Handy Approach to TBSA Estimation

The Palmer Method offers a straightforward approach to estimating TBSA, particularly for smaller burns. This technique uses the patient’s palm as a reference measurement.

How does the Palmer Method work?

The length of the patient’s palm, from wrist to fingertip, is considered to represent approximately 1% of their total body surface area. Medical staff can use this as a quick reference to estimate the size of burn injuries.

Advantages of the Palmer Method

Easy to use and remember
Requires no additional tools or charts
Useful for estimating small to medium-sized burns

Limitations of the Palmer Method

Can lead to overestimation of burn size (by 10-20%)
Less accurate for children, as their palm-to-body ratio differs from adults
Not suitable for large or extensive burns

Comparing TBSA Calculation Methods: Accuracy vs. Practicality

When it comes to TBSA calculation, medical professionals must balance accuracy with practicality, especially in emergency situations. Each method has its strengths and weaknesses:

Method	Accuracy	Speed	Ease of Use
Lund and Browder Chart	High	Moderate	Moderate
Wallace Rule of Nines	Moderate	High	High
Palmer Method	Low to Moderate	High	High

The choice of method often depends on the specific situation, the severity of the burn, and the available resources. In many cases, a combination of methods may be used to ensure the most accurate assessment possible.

The Impact of TBSA Assessment on Burn Treatment and Care

Accurate TBSA calculation is crucial for several aspects of burn treatment and patient care:

Fluid Resuscitation

TBSA is a key factor in determining the amount of intravenous fluids a burn patient requires. Proper fluid management is essential to prevent complications such as hypovolemic shock or organ failure.

Transfer Decisions

The extent of burns, as measured by TBSA, helps determine whether a patient needs to be transferred to a specialized burn center. Generally, burns covering more than 20% TBSA in adults or 10% in children warrant treatment at a dedicated burn unit.

Treatment Planning

TBSA guides medical professionals in developing an appropriate treatment plan, including wound care, pain management, and potential surgical interventions.

Prognosis

The percentage of TBSA affected by burns is a significant factor in predicting patient outcomes and survival rates. Burns covering more than 30% TBSA can be life-threatening, emphasizing the importance of quick and accurate assessment.

Advancements in TBSA Assessment: The Role of Technology

As medical technology continues to evolve, new methods for TBSA assessment are emerging. These innovations aim to improve accuracy and consistency in burn evaluation:

3D Imaging Technology

Advanced 3D scanning and modeling techniques are being developed to provide more precise TBSA calculations. These tools can create detailed digital representations of a patient’s body, allowing for highly accurate burn area measurements.

Mobile Applications

Smartphone apps are now available that use augmented reality and artificial intelligence to assist in TBSA calculation. These apps can help standardize assessments and reduce human error.

Computer-Aided Analysis

Sophisticated software programs can analyze digital images of burn injuries to calculate TBSA automatically. This technology has the potential to improve consistency and reduce the time required for assessment.

While these technological advancements show promise, their full implementation in hospitals and burn centers is still ongoing. As they become more widely adopted, they may significantly enhance the accuracy and efficiency of TBSA assessment.

Beyond TBSA: Holistic Approaches to Burn Care and Recovery

While TBSA is a critical metric in burn assessment and treatment planning, it’s important to recognize that burn care extends far beyond this initial calculation. A comprehensive approach to burn recovery should address various aspects of a patient’s well-being:

Physical Rehabilitation

Burn survivors often require extensive physical therapy to regain mobility and function. This process may involve stretching exercises, strength training, and specialized techniques to manage scar tissue.

Psychological Support

The emotional impact of burn injuries can be significant. Many patients benefit from counseling, support groups, and other mental health services to address issues such as post-traumatic stress, body image concerns, and adjustment to life after injury.

Wound Care and Scar Management

Ongoing wound care and scar management are crucial components of burn recovery. This may include specialized dressings, pressure garments, and various treatments to minimize scarring and promote healing.

Nutritional Support

Proper nutrition plays a vital role in burn recovery. Patients often require increased caloric and protein intake to support healing and maintain muscle mass during the recovery process.

Community and Social Reintegration

Returning to daily life after a burn injury can be challenging. Support programs that focus on social reintegration, vocational rehabilitation, and building a sense of community among burn survivors are invaluable resources.

Organizations like the Phoenix Society offer a wealth of resources and support for burn survivors and their families. These communities can provide valuable information, emotional support, and connections to others who have experienced similar challenges.

As research in burn care continues to advance, new treatments and therapies are constantly being developed. Staying informed about these advancements and working closely with a multidisciplinary healthcare team can help ensure the best possible outcomes 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.

Estimating body surface area – WikEM

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

Rule of Nines

**Adults**
Anatomic structure	Surface area
Anterior Head	4.5%
Posterior Head	4.5%
Anterior Torso	18%
Posterior Torso	18%
Each Anterior Leg	9%
Each Posterior Leg	9%
Each Anterior Arm	4.5%
Each Posterior Arm	4.5%
Genitalia/Perineum	1%

**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%

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:

734 times

Download electronic version

Download Part 1 (pdf)

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/

/ (date of access: 07/14/2023).

The paper analyzes methods for measuring the surface area of various figures. The author’s method for calculating the surface area of a figure as a surface area of rotation with a preliminary analytical description of the contour of the figure is presented.

Keywords: surface area of revolution, integrals, bodies of complex shape.

To solve certain types of electroplating and metalworking tasks, it is required to know the surface area of the body with which you will have to work. However, it is not always possible to quickly carry out calculations, due to the fact that some parts have an atypical, complex shape. Therefore, it becomes necessary to find the simplest, most convenient and cost-effective way to determine this area.

There are various approaches to solving this problem. For example, Yaskelyain B.V. and Cherednechenko T.F. proposed a method for measuring the surface area of a body, in which a film of a material of constant thickness with the property of hygroscopicity is applied to the body, after covering the surface with a wetting composition. At the same time, the surface area is found from its geometric area, taking into account the ratio of the increment in the length of the film to the geometric length of the surface [1].

Another method was proposed by V. G. Vokhmyanin [2]. It consisted in measuring the weight of two bodies, a simple reference (exemplary) and a measured (complex shape). First, under normal conditions, the weight of the bodies was measured, and then they were cooled to the water condensation temperature and weighed again. The area was calculated by finding the quotient from dividing the change in the weight of the measured body by the change in the weight of the reference. In this case, the resulting number is the surface area expressed in units of the reference body. This method, compared with similar ones, is characterized by high performance, simplicity, low cost and high accuracy.

The method for measuring the surface area proposed by V.S. Akselrod and G.M. Rokhlina [3] makes it possible to measure the area of a flat part of a complex shape and is based on measuring the capacitance of a capacitor. The area of the product is equal to the product of the ratio of the capacitance of the capacitors, one of the plates of which is the measured product or the reference product.

ED Grazhdannikov proposed a method for determining the magnitude of the surface of solids, based on measuring the reduction in the times of spin-lattice and spin-spin magnetic relaxation of nuclei in a liquid layer covering the surface of the solid phase [4]. This method is designed to determine the surface of a wide range of applied substances and carriers, and measurements can be taken directly in the course of the reaction. To determine the surface area by this method, a product standard is needed, the surface area of which can be measured in another way.

B. D. Razuvaeva and K. S. Lytkin, studying methods for determining the surface area of complex products, came to the conclusion that the dissolution method is quite reliable in measuring the surface area of a part [5]. It is based on the fact that the amount of metal dissolved in a liquid per unit of time is proportional to the size of the metal surface. To determine the surface area by this method, a reference product with a known surface area is required.

Each of the presented methods involves the implementation of certain chemical operations with the product, and often the presence of a reference body. At the same time, turning to mathematical tools, it is possible to calculate the surface area of the body analytically at lower cost.

For example, if a product has central symmetry, then it can be considered as a body of revolution. Then its surface area can be calculated as the surface area of rotation by the formula:

2 ₂ – borders, in which the function is defined.

Consider a more detailed application of this method on a particular example. Let’s determine the surface area of a chess pawn (Fig. 1.).

Fig. 1. Chess pawn

Let’s place the contour of the investigated body in the XOY Cartesian coordinate system (Fig. 2.).

Different sections of the contour can be defined with different view functions. So it is possible to select 8 such functions that define the contour of the lateral surface for 8 sections. Since we are looking for the area of the lateral surface, we do not consider the area of \u200b\u200bthe base of the figure.

1) With – function –

2) With – function –

3) With – function –

4) With – function –

5) With – function –

6) With – function –

7) With – function –

9000 2 8) At – function –

Fig. 2. Pawn contour in the coordinate system

Having found these functions, we can calculate the surface area of these sections. In situations where the function has the form , the surface area of the section will be calculated in the same way as the surface area of the cylinder, according to the formula, but in this case – , and , where and are the coordinates of the beginning and end of the section, respectively.

So, for the first and fourth sections, the surface area is respectively: , .

For other sections, the formula will be used to calculate the surface area of rotation along the OX axis.

This is how we calculate the surface area of the second section:

Further, similarly, we obtain the values of the surface area of the remaining sections:

, , , , .

The final surface area is found as the sum of the surface areas of the plots:

This method can be used to determine the surface area of bodies along with those previously mentioned. It will be especially convenient if the product has central symmetry. The method is distinguished by accuracy and economic benefits.

Literature:

1. Yaskelyain B. V., Cherednenko T. F. A method for measuring the surface area of a body of complex shape [Electronic resource] // NEB: National Electronic Library — URL: https://rusneb.ru/catalog/ 000224_000128_0093005691_19950720_A_RU/ (accessed 22.02.2022)

2. Vokhmyanin V. G. V. G. Vokhmyanin’s method for measuring the surface area of a body of complex shape [Electronic resource] // FREEPATENT: patent search in the Russian Federation — URL: https:// www .freepatent.ru/patents/2040776 (accessed 02/22/2022)

3. Akselrod V. S., Rokhlina G. M. Method for determining the surface area of electrically conductive products [Electronic resource] // NEB: National Electronic Library — URL: https://viewer.rusneb.ru/ru/000224_000128_0000273447_19700615_A1_SU?page=1&rotate=0&theme=white (accessed 22.02.2022)

4. Grazhdannikov E. D. Method for determining the surface area of solids [Electronic resource] // NEB: National Electronic Library — URL: https://viewer .rusneb.ru/ru/000224_000128_0000176457_19651102_A1_SU? Page = 1 & Rotate = 0 & Theme = White (date of 02.22.2022)

5. Razuvaeva B. D., Lytkin K. S. express Method of Krivoline’s measurement and fact Tour surfaces [Electronic resource] // Precious materials – URL: http://jewelpreciousmetal.ru/technology_other_surfacearea.php ((Accessed 02/22/2022)

Basic terms (automatically generated) : surface area, complex shape, function, surface area of revolution, XOY, lateral surface, central symmetry, chess pawn, reference product, reference body.

Keywords

surface area of rotation,

integrals,

bodies of complex shape

surface area of revolution, integrals, bodies of complex shape

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