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Burn surface area calculation: Determining Total Body Surface Area

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


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.


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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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  • 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


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).


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.


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Medicina Online

Burn area determination

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

many schemes for determining the area
burn surface.

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.

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

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

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.

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

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

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

Formulation example

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

the diagnosis is accompanied in the medical history
graphic diagrams.


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.

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.

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

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.

Hettiaratchy S, Papini R. Initial management of a major burn: II – assessment and resuscitation. BMJ 2004;329;101–3
Wachtel, T.L. The inter-rater reliability of estimating the size of burns from various burn area chart drawings/ T.