What is Total Body Surface Area (TBSA). How is TBSA calculated in burn patients. What are the main methods for determining TBSA. How accurate are different TBSA calculation techniques. Why is TBSA assessment critical in burn care.

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 burns in patients. This assessment plays a vital role in determining the appropriate course of treatment, including fluid resuscitation, transfer decisions, management strategies, and overall prognosis. But what exactly is TBSA, and how is it calculated?

TBSA refers to the percentage of a person’s body that has been affected by burns. Accurate and swift TBSA assessment is critical in burn care, as it directly influences the patient’s treatment plan and potential outcomes. In severe cases where burns cover 30% or more of the body surface area, the injury can be life-threatening, emphasizing the importance of quick and precise evaluation.

The Three Primary Methods of TBSA Calculation

Medical professionals typically rely on three main methods to calculate TBSA in burn patients:

1. Lund and Browder Chart
2. Wallace Rule of Nines
3. Palmer Method

Each of these methods has its own unique approach, advantages, and limitations. Let’s explore each one in detail to understand how they contribute to burn assessment and patient care.

Lund and Browder Chart: The Most Accurate TBSA Assessment Tool

The Lund and Browder (LB) chart is widely regarded as the most accurate method for calculating TBSA in burn patients. How does this chart work, and why is it considered superior to other methods?

The LB chart features detailed diagrams of the human body, both anterior and posterior views. Each region of the body is assigned a specific percentage, ranging from 1% to 13%. As medical staff examine a patient’s burns, they add up the percentages of affected areas to determine the total TBSA.

While the Lund and Browder chart offers high accuracy, it does have some limitations:

• Requires quick mental calculations
• May lead to variations in results between different medical staff members
• Can be time-consuming in emergency situations

Despite these drawbacks, the LB chart remains a gold standard in TBSA assessment due to its comprehensive approach and attention to detail.

Wallace Rule of Nines: Quick TBSA Estimation for Second and Third-Degree Burns

The Wallace Rule of Nines is a popular method for assessing TBSA, particularly in cases of second and third-degree burns. This technique offers a simplified approach to burn area calculation, making it especially useful in emergency situations where rapid assessment is crucial.

How does the Wallace Rule of Nines work? This method divides the body into sections, each representing a multiple of 9% of the total body surface area:

• Each arm: 9%
• Each leg: 18%
• Front of torso: 18%
• Back of torso: 18%
• Head: 9%
• Genitals/perineum: 1%

The simplicity of this method allows for quick mental calculations, enabling medical professionals to rapidly determine the extent of burns and initiate appropriate treatment protocols.

Advantages of the Wallace Rule of Nines

• Fast and easy to use in emergency situations
• Facilitates quick communication of burn extent among medical team members
• Helps in rapid decision-making for fluid resuscitation and level of care

Limitations of the Wallace Rule of Nines

• Less accurate than the Lund and Browder chart
• May not account for variations in body proportions, especially in children
• Can lead to overestimation or underestimation in certain body areas

The Palmer Method: Using Hand Size as a Reference for TBSA Calculation

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

How does the Palmer Method work? In this approach, the length of the patient’s palm (with fingers together) is used as a reference measurement. The area from the wrist to the fingertips is considered to represent approximately 1% of the total body surface area.

Advantages of the Palmer Method

• Quick and easy to use, especially for small burns
• Doesn’t require specialized charts or memorization of percentages
• Can be useful in field assessments or resource-limited settings

Limitations of the Palmer Method

• 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 size can affect accuracy

It’s important to note that the Palmer Method should be used primarily for initial estimates and is best suited for small burns. For more comprehensive assessments, medical professionals typically rely on the Lund and Browder chart or the Wallace Rule of Nines.

Advancements in TBSA Assessment: 3D Technology and Digital Tools

As medical technology continues to evolve, new methods for TBSA assessment are emerging. One of the most promising developments is the use of 3D technology and digital applications to enhance the accuracy and speed of burn area calculations.

How are these new technologies improving TBSA assessment? 3D models of human anatomy, available on desktop and mobile applications, allow medical teams to quickly and accurately assess burn injuries. These digital tools can provide more precise measurements and reduce the potential for human error in calculations.

Benefits of 3D Technology in TBSA Assessment

• Improved accuracy in burn area calculations
• Faster assessment times, especially for complex burn patterns
• Standardization of measurements across different medical professionals
• Enhanced visualization of burn distribution and depth
• Potential for better tracking of burn healing over time

While the full implementation of these advanced technologies is still in progress across hospitals and burn centers in the United States, they represent a significant step forward in burn care and TBSA assessment.

The Importance of Accurate TBSA Assessment in Burn Care

Why is precise TBSA calculation so crucial in the treatment of burn patients? The accuracy of TBSA assessment has far-reaching implications for patient care, influencing various aspects of treatment and recovery:

• Fluid Resuscitation: TBSA determines the amount of intravenous fluids a patient needs to prevent shock and maintain organ function.
• Transfer Decisions: The extent of burns helps determine whether a patient needs to be transferred to a specialized burn center.
• Treatment Planning: TBSA guides decisions about wound care, surgical interventions, and overall management strategies.
• Prognosis: The percentage of body surface area affected is a key factor in predicting patient outcomes and recovery timelines.
• Research: Accurate TBSA data is essential for conducting meaningful studies and advancing burn care practices.

Given these critical factors, the ongoing refinement and improvement of TBSA assessment methods remain a priority in the field of burn care.

Beyond TBSA: Holistic Approach to Burn Patient Care

While TBSA assessment is a crucial first step in burn diagnostics and treatment, it’s important to recognize that burn care extends far beyond this initial evaluation. What other factors contribute to comprehensive burn patient care?

• Psychological Support: Burn survivors often face significant emotional and psychological challenges during recovery.
• Physical Rehabilitation: Specialized therapy helps patients regain mobility and function in affected areas.
• Wound Care: Advanced techniques in wound management promote healing and minimize scarring.
• Nutritional Support: Proper nutrition is crucial for healing and recovery in burn patients.
• Long-term Follow-up: Ongoing care and monitoring help address complications and support overall recovery.

Organizations like the Phoenix Society offer valuable resources and support for burn survivors, helping them navigate the complex journey of treatment and recovery. These resources can provide essential information, community support, and guidance for patients and their families throughout the healing process.

The Role of Patient Education in Burn Care

Empowering burn survivors with knowledge about their condition and treatment options is an integral part of the recovery process. How can patients actively participate in their care and recovery?

• Understand the basics of TBSA and its implications for treatment
• Ask questions about different assessment methods used in their care
• Learn about wound care techniques and participate in self-care when appropriate
• Engage in physical therapy and rehabilitation exercises as recommended
• Seek psychological support and join support groups for burn survivors
• Stay informed about advancements in burn care and treatment options

By actively engaging in their treatment and recovery process, burn survivors can play a crucial role in optimizing their outcomes and quality of life post-injury.

As we continue to advance our understanding of burn assessment and treatment, the integration of accurate TBSA calculation methods, advanced technologies, and comprehensive care approaches will undoubtedly lead to improved outcomes for burn patients. The ongoing collaboration between medical professionals, researchers, and patients themselves remains essential in driving progress in this critical field of healthcare.

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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