How does the EasyTBSA app compare to traditional methods for calculating burn surface area. What are the implications of accurate burn size estimation for patient care. Why is precise TBSA calculation crucial in burn management.

The Challenge of Accurate Burn Size Estimation

Accurately estimating the total body surface area (TBSA) affected by burns is crucial for proper patient management, yet it remains a significant challenge in emergency care. Incorrect estimates can lead to serious consequences, including:

• Unnecessary transfers to specialized burn centers
• Fluid overload during resuscitation
• Inadequate treatment of severe burns

These issues are particularly pronounced in pediatric burn cases, where traditional estimation methods often fall short. To address this critical need, researchers developed the EasyTBSA smartphone application, designed to provide more precise TBSA calculations using a body-part by body-part approach.

EasyTBSA: A Novel Approach to Burn Surface Area Calculation

The EasyTBSA app represents a significant advancement in burn assessment technology. But how does it work? The application utilizes a detailed, segmented approach to burn estimation:

• Users input burn locations on specific body parts
• The app calculates TBSA based on standardized body proportions
• Results are provided quickly and accurately

This method aims to reduce the subjective nature of traditional estimation techniques, potentially leading to more consistent and reliable results across different healthcare providers.

Comparing EasyTBSA to Established Burn Estimation Methods

A comprehensive validation study was conducted to assess the accuracy of EasyTBSA compared to three well-established methods of burn size estimation:

1. Lund-Browder Chart
2. Rule of Nines
3. Rule of Palms

The study design was rigorous, involving 24 healthcare providers who estimated burn sizes on moulaged manikins representing different age groups (infant, child, and adult) and varying burn severities (small, medium, and large).

Study Methodology

To ensure accurate comparisons, the researchers employed advanced techniques:

• 3D scans of manikins to determine true body surface areas
• Multivariable modeling to control for manikin size and estimation method
• Calculation of accuracy based on the difference between estimated and actual TBSA

This comprehensive approach allowed for a fair and detailed evaluation of each method’s performance across various scenarios.

Remarkable Results: EasyTBSA’s Superior Accuracy

The study’s findings were striking, demonstrating a clear advantage for the EasyTBSA application. Here’s how the methods compared in terms of accuracy (measured as the difference between estimated and actual TBSA):

1. EasyTBSA: -0.01% (SD 3.59%)
2. Rule of Palms: 3.92% (SD 10.71%)
3. Lund-Browder Chart: 4.42% (SD 5.52%)
4. Rule of Nines: 5.05% (SD 6.87%)

These results indicate that EasyTBSA consistently provided the most accurate estimates across all age groups and burn sizes. But what makes this app so effective?

Factors Contributing to EasyTBSA’s Accuracy

• Detailed body-part segmentation
• Elimination of subjective visual estimation
• Standardized calculations based on validated body proportions
• User-friendly interface reducing input errors

The combination of these factors allows EasyTBSA to overcome many of the limitations associated with traditional estimation methods.

Implications for Burn Management and Patient Care

The improved accuracy offered by EasyTBSA has far-reaching implications for burn management and patient outcomes. How might this new tool impact clinical practice?

• More appropriate triage decisions for burn center transfers
• Optimized fluid resuscitation protocols
• Enhanced wound care planning
• Improved resource allocation in mass casualty events

By providing healthcare providers with a more reliable method of burn size estimation, EasyTBSA has the potential to significantly improve the standard of care for burn patients, particularly in pediatric cases where accurate assessment has historically been most challenging.

Overcoming Limitations of Traditional Burn Estimation Methods

While established methods like the Lund-Browder Chart and Rule of Nines have been widely used for decades, they come with inherent limitations:

• Difficulty in accurately estimating irregular burn patterns
• Variations in body proportions, especially in children and obese patients
• Reliance on memorization of standardized percentages
• Potential for significant inter-observer variability

EasyTBSA addresses these issues by providing a standardized, digital approach that adapts to individual patient characteristics and reduces the potential for human error.

The Rule of Palms: A Surprising Runner-Up

Interestingly, the study found that the Rule of Palms performed better than both the Lund-Browder Chart and the Rule of Nines. This method, which estimates burn size based on the area of the patient’s palm (roughly 1% of TBSA), may offer a quick and relatively accurate alternative when digital tools are unavailable.

Future Directions: Integrating Technology in Burn Care

The success of EasyTBSA opens up new possibilities for the integration of technology in burn assessment and management. What other advancements might we see in the near future?

• AI-powered image analysis for burn depth assessment
• Telemedicine platforms for remote burn consultations
• Wearable devices for continuous monitoring of burn wound healing
• Virtual reality simulations for burn care training

As these technologies continue to evolve, they have the potential to revolutionize burn care, improving outcomes and reducing the burden on specialized burn centers.

Implementing EasyTBSA in Clinical Practice

While the study results are promising, successful implementation of EasyTBSA in real-world clinical settings will require careful consideration. Key factors to address include:

• Training programs for healthcare providers
• Integration with existing electronic health record systems
• Protocols for app use in emergency situations
• Ongoing validation studies in diverse patient populations

By addressing these factors, healthcare systems can maximize the benefits of this innovative tool and improve burn care across the board.

Potential Challenges and Limitations

Despite its advantages, EasyTBSA may face some challenges in widespread adoption:

• Resistance to change from practitioners comfortable with traditional methods
• Concerns about reliance on technology in emergency situations
• Need for regular updates and maintenance of the app
• Potential for technical issues or user error

Addressing these concerns through rigorous testing, user feedback, and continuous improvement will be crucial for the long-term success of EasyTBSA.

The Importance of Accurate TBSA Calculation in Burn Management

Understanding the critical role of precise TBSA calculation is essential for appreciating the value of tools like EasyTBSA. Accurate burn size estimation impacts numerous aspects of patient care:

• Fluid resuscitation protocols
• Nutritional requirements
• Wound care strategies
• Prognosis and mortality risk assessment
• Decisions regarding skin grafting and other surgical interventions

By improving the accuracy of these foundational assessments, EasyTBSA has the potential to enhance every stage of burn management, from initial triage to long-term rehabilitation.

The Parkland Formula: A Case Study in TBSA Importance

The Parkland Formula, widely used for calculating fluid resuscitation needs in burn patients, relies heavily on accurate TBSA estimation. This formula recommends 4mL of fluid per kilogram of body weight per percent TBSA burned for the first 24 hours post-injury. Consider the following scenario:

A 70kg adult with an estimated 30% TBSA burn would receive:

4mL x 70kg x 30% = 8,400mL of fluid in the first 24 hours

Now, imagine if the burn was overestimated by just 5%:

4mL x 70kg x 35% = 9,800mL of fluid

This 1,400mL difference could potentially lead to fluid overload and associated complications. Conversely, underestimation could result in inadequate resuscitation and organ dysfunction. This example underscores the critical importance of accurate TBSA calculation in burn management.

EasyTBSA: A Step Towards Standardized Burn Care

The development and validation of EasyTBSA represent a significant step towards standardizing burn assessment and care across different healthcare settings. By providing a consistent, accurate method for TBSA calculation, this tool has the potential to:

• Reduce variability in burn size estimation between providers
• Improve communication between emergency responders and burn specialists
• Facilitate more accurate research and data collection in burn care
• Enhance training programs for new healthcare providers

As adoption of EasyTBSA grows, it may contribute to the development of more refined and evidence-based protocols for burn management, ultimately leading to better patient outcomes.

The Role of Technology in Advancing Medical Practice

The success of EasyTBSA highlights the broader potential for technology to improve medical practice. By leveraging the power of smartphones and custom algorithms, this application demonstrates how innovative tools can address long-standing challenges in healthcare. Similar approaches could be applied to other areas of medicine, such as:

• Wound measurement and tracking
• Medication dosing calculations
• Risk assessment for various medical conditions
• Rehabilitation progress monitoring

As healthcare continues to evolve, the integration of user-friendly, evidence-based technological solutions will likely play an increasingly important role in improving patient care and outcomes.

The validation study of EasyTBSA marks a significant milestone in burn care, offering a more accurate and reliable method for calculating total body surface area affected by burns. As this tool becomes more widely adopted, it has the potential to improve patient outcomes, optimize resource allocation, and advance the field of burn management. The success of EasyTBSA also serves as a model for how technology can be leveraged to address long-standing challenges in healthcare, paving the way for further innovations in medical practice.

EasyTBSA as a method for calculating total body surface area burned: a validation study

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Original research

EasyTBSA as a method for calculating total body surface area burned: a validation study

1. Cindy D Colson1,
2. Emily C Alberto1,
3. Zachary P Milestone1,
4. Nikita Batra1,
5. Tyler Salvador2,
6. Hadi Fooladi2,
7. Kevin Cleary2,
8. Rima Izem3,4,
9. http://orcid.org/0000-0003-4465-9117Randall S Burd1

1. ¹
   Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DC, USA
   
2. ²
   Bioengineering Operations, Children’s National Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, USA
   
3. ³
   Department of Pediatrics, Children’s National Research Institute, Washington, DC, USA
   
4. ⁴
   School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
   

1. Correspondence to
   Dr Randall S Burd, Division of Trauma and Burn Surgery, Children’s National Health System, Washington, DC 20010, USA; RBurd{at}childrensnational. org

Abstract

Background Current methods of burn estimation can lead to incorrect estimates of the total body surface area (TBSA) burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centres and fluid overload during resuscitation. To address these challenges, we developed a smartphone application (EasyTBSA) that calculates the TBSA of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the EasyTBSA application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines and Rule of Palms).

Methods Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child and adult) with different TBSA burns (small <20%, medium 20%–49% and large >49%). We calculated the accuracy of each method as the difference between the user-estimated and actual TBSA. The true value of the complete body surface area of the manikins was obtained by three-dimensional scans. We used multivariable modelling to control for manikin size and method.

Results Among all age groups and burn sizes, the EasyTBSA application had the greatest accuracy for burn size estimation (−0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%) and the Rule of Nines (5.05%, SD 6.87%).

Conclusions The EasyTBSA application may improve the estimation of TBSA compared with existing methods.

• burns
• triage
• clinical assessment
• emergency responders
• ED

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://dx.doi.org/10.1136/emermed-2022-212308

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• burns
• triage
• clinical assessment
• emergency responders
• ED

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

• Handling editor Kirsty Challen

• Contributors All authors have made substantial contributions and met criteria for authorship as defined as (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be resubmitted.CC is the guarantor.

• Funding RZ’s work on this project was supported by grant 5UL1TR001876-03 from the National Center for Research Resources (Guay-Woodford).

• Competing interests None declared.

• Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the Methods section for further details.

• Provenance and peer review Not commissioned; externally peer reviewed.

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Calculating the surface area of a burn: the rule of 9

RESCUERS’ RADIO IN THE WORLD? VISIT THE EMS RADIO BOOTH AT EMERGENCY EXPO

Along with the depth of the burn (which can be first, second, third or fourth degree), the severity of burns is also determined by the extent of the injured area; the greater this is, the more insidious is the danger to the burn victim’s life.

There are numerous tables to determine the extent of the burned skin as a percentage of the total body surface area (TBSA).

STRETCHERS, SPINE BOARDS, LUNG VENTILATORS, EVACUATION CHAIRS: SPENCER PRODUCTS ON THE DOUBLE BOOTH AT EMERGENCY EXPO

The simplest and most schematic method is Wallace’s ‘rule of 9’.

It is simple and quick to use, especially for an initial classification at the scene of an accident.

After hospitalisation, more complex tables are used that take into account the exact percentages represented by each body segment according to age.

The most commonly used is the Lund and Browder table you see below:

Used at the time of admission to Large Burn Centres, these tables allow the precise mapping of lesions on pre-printed forms, colour-coded for different depths.

A useful addition to the calculation of the size of partially burned skin areas is the palm of the hand including the patient’s fingers, which represents 1% of the TBSA.

THE IMPORTANCE OF TRAINING IN RESCUE: VISIT THE SQUICCIARINI RESCUE BOOTH AND FIND OUT HOW TO BE PREPARED FOR AN EMERGENCY

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Source

Medicina Online

Burn area determination

For
determining the severity of the burn
the measurement of its area is important.
It is important to know not so much the absolute
value, how much percentage
burn area to total surface area
body.

Suggested
many schemes for determining the area
burn surface.

Most
A simple method is A. Wallace.
known as the “rule
nines.” Proposed in 1951. Method
based on the allocation of anatomical
areas whose area as a percentage
is equal to a multiple of 9. According to this
the surface of the head and neck is
9% front and back
torso – 18% each, each upper limb
– 9%, each lower limb – 18
%, perineum and genitals – 1%. .
The method is not very accurate, but allows you to quickly
determine the area of ​​the burn surface.

close
is essentially the method of I. I. Glumov or
“rule of the palm”.

Square
palm is approximately 1%
body surface. Based on this,
determine the number of palms
laid on the surface of the burn and
calculate its area. Usually the rule
palms” and “rule of nines” are used
simultaneously.

More
the exact surface of the burn can be determined
according to the method of B. N. Postnikov (1949). Burn
the surface is covered with sterile
cellophane sheets and circled
burn outline. Then a cellophane sheet
put on graph paper and
calculate the area of ​​the burn surface
in square centimeters. Based
on the obtained values ​​of the absolute
area, calculate the relative
value in relation to the entire surface
body percentage. The method is very labor intensive.
and is currently not applicable.

Can
apply area measurement scheme
burns according to the method of G. D. Vilyavina. For this
skizzes are used, special
stamps with a silhouette of a man and applied
squares on it. Squares size
5×5 mm = 25 sq. mm and 10 mm x10 mm = 100 sq. mm
correspond on the human body to the same
the number of sq. cm (25 and 100 sq. cm), as the size
silhouette is 10 times smaller than a human figure
170 cm tall, burn areas are outlined
on the diagram with colored pencils area,
according to the degree of injury.
Average total surface area
human body is taken as 17,000 sq. cm.
Percentage of burn area
to total body surface area
calculated from tables. For measuring
areas of burns in children proposed
special table, it takes into account
ratio of body parts, in various
age.

More
a simple version was proposed by V. A. Dolinin.
Front and back silhouettes on the stamp
The human body is divided into 100 segments.
Each segment is 1% of the surface
body.

Diagnosis
in case of burns should reflect the severity
damage, so when formulating it
the type of burn (thermal,
chemical, electrical), degree,
total area, area of ​​deep
lesions and localization. By specifying the type
burn, its characteristics reflect in
the form of a fraction. Write in the numerator
expressed as a percentage of the total area
burn and in brackets – the area of ​​deep
defeat. The denominator indicates
burn degree. After the fraction is noted
localization.

Formulation example
diagnosis.

Thermal
burn 12% (5%)/II-IIIb
Art. back.

Usually
the diagnosis is accompanied in the medical history
graphic diagrams.

DEFINITION
BURN PROGNOSIS

burns
under no circumstances should it be considered
as a local pathological process.
pathophysiological changes,
developing in the body, lead to
severe impairment of vital
systems and may endanger the life of the victim.
Knowing the degree and depth of the burn, you can
anticipate future developments
pathological process and outcome.

critical
a condition is considered a total (100%) burn
I degree and burns II or IIIa degree more
30% of the body surface. life-threatening
are also burns IIIb and IV degree
face, genitals and perineum, if they
exceed 10%; limb burns and
torso with an area of ​​​​more than 15%. For children
and the elderly are dangerous
smaller burns.

For
more objective burn prognosis
proposed methods for determining the index
Frank and the “Rule of the Hundred”.

Determination of the area of ​​the burn surface according to Lund-Browder » Medvestnik

The assessment is made according to the following parameters: the sum of % of the body surface area.

Lund-Browder burn surface area assessment, % of body surface

Part of the body	0 – 1 year	1 – 4 years	5 – 9 years	10 – 14 years old	15 years old	Adults
1/2 head	9.5	8.5	6.5	5.5	4.5	3.5
1/2 neck	2	2	2	2	2	2
1/2 body	13	13	13	13	13	13
Buttock	2. 5	2.5	2.5	2.5	2.5	2.5
Genitals	1	1	1	1	1	1
1/2 arms (each)	2	2	2	2	2	2
1/2 forearm (each)	1.5	1.5	1.5	1.5	1.5	1.5
1/2 brush (each)	1.5	1.5	1.5	1.5	1.5	1.5
1/2 thigh (each)	2.75	3.25	4	4.25	4.5	4.75
1/2 drumsticks (each)	2.5	2.5	2.75	3	3.25	3.5
1/2 foot (each)	1. 75	1.75	1.75	1.75	1.75	1.75

According to various sources of literature, the estimate of the affected surface area using the Lund’a and Browder’a table has high reliability and validity. Yes, T.L. Wachtel et al. in their work showed that the method is characterized by high inter-expert reliability. However, in cases of extensive burns, as well as when burns have a complex shape, the reliability indicators are characterized by lower values. It is shown that reliability depends to a greater extent on the experience of working with the diagram and to a lesser extent on the duration of the doctor’s work in the field of combustiology.

Sources

Hettiaratchy S, Papini R. Initial management of a major burn: II – assessment and resuscitation. BMJ 2004;329;101–3

www.researchgate.net

Wachtel, T.L. The inter-rater reliability of estimating the size of burns from various burn area chart drawings/ T.