Body surface area diagram. Total Body Surface Area (TBSA) Assessment: Methods and Importance in Burn Treatment

09.07.202214.07.2023 by alexxlab

What is Total Body Surface Area (TBSA). How is TBSA calculated in burn patients. Why is TBSA assessment critical in burn treatment. What are the main methods used to determine TBSA. How accurate are different TBSA calculation methods. What are the advantages and limitations of each TBSA assessment technique.

Содержание

Understanding Total Body Surface Area (TBSA) in Burn Treatment

Total Body Surface Area (TBSA) is a crucial concept in burn treatment and assessment. It refers to the percentage of a patient’s body affected by burns and plays a vital role in determining the severity of burn injuries. TBSA calculations inform critical decisions throughout a burn patient’s treatment journey, including fluid resuscitation, transfer decisions, ongoing management, prognosis, and research.

Why is TBSA assessment so important? The accuracy and speed of initial TBSA calculations can significantly impact patient outcomes. Burn injuries affecting over 30% of TBSA can be potentially fatal, making rapid and precise assessment essential for timely intervention.

The Three Primary Methods of TBSA Calculation

Medical professionals primarily use three methods to calculate TBSA in burn patients:

Lund and Browder Chart
Wallace Rule of Nines
Palmer Method

Each method has its unique approach, advantages, and limitations. Let’s explore these techniques in detail to understand how they contribute to burn assessment and treatment planning.

The Lund and Browder Chart: Precision in TBSA Calculation

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 each body region ranging from 1% to 13%.

How does the Lund and Browder Chart work?

When using the LB chart, medical staff examine the burn injury and add up the percentages of affected body regions to calculate the total TBSA. This method provides a more nuanced and precise assessment compared to other techniques.

Advantages of the Lund and Browder Chart

High accuracy in TBSA calculations
Detailed body region breakdown
Suitable for various burn types and severities

Limitations of the Lund and Browder Chart

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

The Wallace Rule of Nines: Quick TBSA Estimation

The Wallace Rule of Nines is a popular method for assessing second- and third-degree burn injuries. This technique assigns percentage values to body regions in multiples of nine, allowing for rapid TBSA estimation.

How does the Wallace Rule of Nines work?

In this method, each arm is assigned 9% of TBSA, while each leg accounts for 18%. Medical professionals can quickly sum up the burned areas based on visual examination to determine the total TBSA affected.

TBSA Percentages According to the Rule of Nines (Adults)

Head and Neck: 9%
Each Arm: 9%
Chest: 18%
Abdomen: 18%
Upper Back: 18%
Lower Back: 18%
Each Leg: 18%
Genitals: 1%

Advantages of the Wallace Rule of Nines

Simple and quick estimation
Easy to calculate fluid replacement requirements
Facilitates rapid communication of burn severity within medical teams

Limitations of the Wallace Rule of Nines

Less precise than the Lund and Browder Chart
May not account for variations in body proportions
Less suitable for partial-thickness burns or irregular burn patterns

The Palmer Method: Hand-Based TBSA Assessment

The Palmer Method offers a unique approach to TBSA calculation by using the patient’s palm as a reference measurement. This technique is particularly useful for assessing smaller burns or when other methods are impractical.

How does the Palmer Method work?

In this method, the length of the patient’s palm (including fingers) is used as a reference, with each palm length representing approximately 1% of TBSA. Medical staff can estimate the burn size by comparing it to the patient’s palm size.

Advantages of the Palmer Method

Quick and easy to use, especially for small burns
Requires no specialized equipment
Useful in field assessments or resource-limited settings

Limitations of the Palmer Method

Less accurate than other methods, particularly for larger burns
Can lead to overestimation of burn size by 10-20%
Variations in hand-to-body ratios across age groups and individuals affect accuracy

It’s important to note that the average adult’s hand actually comprises about 0.78% of their total body surface area, while in children, it can be more than 1%. This discrepancy can contribute to the potential overestimation when using the Palmer Method.

Advancements in TBSA Assessment: 3D Technology

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 to enhance the accuracy and consistency of burn area calculations.

How does 3D technology improve TBSA assessment?

3D models of human anatomy, accessible through 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 variability associated with traditional methods.

Advantages of 3D technology in TBSA assessment

Increased accuracy in burn area calculations
Improved consistency across different medical professionals
Potential for integration with electronic health records
Enhanced visualization of burn patterns and distributions

Challenges in implementing 3D technology

Ongoing process of full rollout and implementation in hospitals and burn centers
Need for training and familiarization among medical staff
Initial costs associated with technology adoption

As 3D technology becomes more widely available and integrated into burn care protocols, it has the potential to significantly improve the accuracy and efficiency of TBSA assessments.

The Impact of TBSA Assessment on Burn Treatment

Accurate TBSA calculation is crucial for several aspects of burn treatment and patient care. Understanding the implications of TBSA assessment helps both medical professionals and patients navigate the treatment process more effectively.

How does TBSA assessment influence burn treatment decisions?

Fluid Resuscitation: TBSA calculations help determine the appropriate amount of intravenous fluids needed to prevent shock and maintain organ function.
Transfer Decisions: Severe burns covering a large TBSA may require transfer to specialized burn centers for advanced care.
Wound Management: The extent of TBSA affected guides decisions on wound care strategies, including dressing types and frequency of changes.
Nutritional Support: TBSA calculations inform nutritional requirements, as extensive burns increase metabolic demands.
Prognosis: The percentage of TBSA affected is a key factor in predicting recovery time and potential complications.
Research: Accurate TBSA data is essential for burn studies and the development of new treatment protocols.

Why is precision in TBSA assessment critical?

Overestimation or underestimation of TBSA can lead to suboptimal treatment decisions. For example, overestimating TBSA might result in excessive fluid administration, potentially causing complications like pulmonary edema. Conversely, underestimation could lead to inadequate fluid resuscitation, increasing the risk of organ failure and other serious complications.

Beyond TBSA: Comprehensive Burn Care and Recovery

While TBSA assessment is a crucial first step in burn treatment, it’s important to recognize that burn care extends far beyond initial calculations. Comprehensive burn treatment involves a multidisciplinary approach that addresses both physical and psychological aspects of recovery.

What are the key components of comprehensive burn care?

Wound Management: Includes cleaning, debridement, and appropriate dressing selection.
Pain Management: Tailored pain relief strategies to ensure patient comfort during treatment and recovery.
Infection Prevention: Rigorous protocols to minimize the risk of wound infections.
Rehabilitation: Physical and occupational therapy to restore function and prevent contractures.
Psychological Support: Counseling and support groups to address emotional and psychological impacts of burn injuries.
Scar Management: Techniques to minimize scarring and improve aesthetic outcomes.
Nutritional Support: Specialized diets to support healing and meet increased metabolic demands.

How can burn survivors support their recovery journey?

Recovery from burn injuries is a complex process that extends beyond medical treatment. Burn survivors can take additional steps to support their healing and adaptation:

Education: Learn about burn injuries, treatment options, and recovery processes.
Community Engagement: Connect with support groups and other burn survivors for shared experiences and coping strategies.
Self-Care: Prioritize physical and mental well-being through proper nutrition, exercise, and stress management techniques.
Advocacy: Participate in burn awareness initiatives and support research efforts.
Goal Setting: Work with healthcare providers to set realistic recovery milestones and celebrate progress.

Organizations like the Phoenix Society offer valuable resources, support networks, and educational materials for burn survivors and their families. These resources can play a crucial role in navigating the challenges of burn recovery and fostering a sense of community among survivors.

The Future of TBSA Assessment and Burn Care

As medical technology and understanding of burn physiology continue to advance, the field of burn care is poised for significant developments. These advancements promise to improve the accuracy of TBSA assessment and enhance overall treatment outcomes for burn patients.

What emerging technologies might impact TBSA assessment?

Artificial Intelligence: Machine learning algorithms could analyze burn images for more precise TBSA calculations.
Augmented Reality: AR overlays could assist medical professionals in visualizing burn areas more accurately.
Thermal Imaging: Advanced thermal cameras might help distinguish burn depths and extents more precisely.
Biomarkers: Identification of specific biomarkers could provide additional data to complement visual TBSA assessments.

How might future developments in burn care impact patient outcomes?

Advancements in burn care technology and techniques have the potential to:

Reduce mortality rates for severe burns
Improve functional outcomes and quality of life for survivors
Decrease recovery time and hospital stays
Enhance scar management and aesthetic results
Provide more personalized treatment plans based on individual patient factors

As research continues and new technologies are developed, the field of burn care will likely see significant improvements in both TBSA assessment accuracy and overall treatment effectiveness. These advancements will contribute to better outcomes and improved quality of life for burn survivors worldwide.

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

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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