How is Total Body Surface Area calculated for burn victims. What are the key features of a professional burn surface area calculator. Why is BSA important in clinical settings. How does the Rule of Nines work for burn assessment.

Understanding Total Body Surface Area (TBSA) in Burn Assessment

Total Body Surface Area (TBSA) is a crucial metric in evaluating the severity of burns and determining appropriate treatment protocols. TBSA represents the percentage of the body affected by burns, which is essential for calculating fluid resuscitation requirements and estimating patient prognosis. Medical professionals use various methods to calculate TBSA, with the most common being the Rule of Nines, Rule of Eights, Rule of Fives, and the Lund and Browder chart.

The Importance of Accurate TBSA Calculation

Precise TBSA calculation is vital for several reasons:

• Determining fluid resuscitation needs using the Parkland Formula
• Assessing burn severity and potential complications
• Guiding treatment decisions and resource allocation
• Estimating mortality risk using tools like the Abbreviated Burn Severity Index (ABSI)

Given the critical nature of these assessments, healthcare providers need reliable and efficient tools to calculate TBSA accurately.

Advanced Features of Professional Burn Surface Area Calculators

Modern burn surface area calculators offer a range of sophisticated features to enhance accuracy and efficiency in burn assessment. Some key capabilities include:

• Vector-based graphics for high-precision detail
• Professional editing tools like brushes and lasso selection
• Enhanced calculation methods considering BMI and body type
• Quick calculators for immediate Parkland Formula results
• Ability to create, view, sort, search, and edit patient records
• Encrypted local storage for patient data security
• Options to share results and export charts

These features enable healthcare professionals to perform rapid, accurate assessments while maintaining patient confidentiality and data integrity.

The Rule of Nines: A Fundamental Approach to TBSA Estimation

The Rule of Nines is a widely used method for estimating TBSA in adult burn victims. This approach divides the body into sections, each representing approximately 9% of the total body surface area:

• Head and neck: 9%
• Each arm: 9% (18% total)
• Chest and abdomen: 18%
• Back: 18%
• Each leg: 18% (36% total)
• Groin: 1%

While the Rule of Nines provides a quick estimate, it may not be as accurate for patients with non-standard body proportions or for pediatric cases. For these situations, alternative methods like the Rule of Eights or the Lund and Browder chart may be more appropriate.

Adapting TBSA Calculations for Special Populations

Recognizing the limitations of standard TBSA calculation methods, advanced burn surface area calculators incorporate specialized approaches for different patient groups:

Rule of Eights for Infants

For infants under 10 kg, the Rule of Eights provides a more accurate estimation of TBSA. This method accounts for the proportionally larger head size in infants compared to adults.

Rule of Fives for Obese Adults

Adults over 80 kg may require the use of the Rule of Fives, which adjusts for the altered body proportions often seen in obese individuals.

BMI-Adjusted Calculations

Some advanced calculators incorporate BMI data to further refine TBSA estimates, accounting for variations in body composition across different patient populations.

The Parkland Formula: Guiding Fluid Resuscitation in Burn Patients

The Parkland Formula is a critical tool in managing burn patients, using TBSA calculations to determine fluid resuscitation requirements. The formula is as follows:

Fluid requirement (in mL) = 4 * (Body weight in kg) * (% TBSA burned)

This calculation provides an estimate of the total fluid volume needed in the first 24 hours post-burn. Half of this volume is typically administered in the first 8 hours, with the remainder given over the next 16 hours. Advanced burn surface area calculators often integrate the Parkland Formula, allowing for rapid fluid requirement estimations based on input TBSA data.

Leveraging Technology for Enhanced Burn Assessment Accuracy

Modern burn surface area calculators utilize various technological advancements to improve assessment accuracy and efficiency:

Vector-Based Graphics

By using Scalable Vector Graphics (SVG), these tools can store burn region data as digital values, allowing for:

• Higher precision in visual feedback and display
• Future-proofing as calculation methods evolve
• Easier data sharing and analysis

Touch-Screen Functionality

Features like two-finger panning, pinch-to-zoom, and touch-to-pan capabilities enable precise input of burn regions, especially on mobile devices.

Reverse-Draw Capabilities

Advanced calculators often include a reverse-draw feature, allowing users to match burn patterns from anterior to posterior views for a more comprehensive assessment.

The Role of Body Surface Area in Clinical Applications Beyond Burns

While burn assessment is a primary application, Body Surface Area (BSA) calculations have broader clinical significance:

Metabolic Mass Estimation

BSA often serves as a more accurate indicator of metabolic mass compared to body weight alone. This is particularly useful in determining energy requirements and drug dosages.

Cardiac Function Assessment

In cardiology, BSA is used to calculate the cardiac index, which relates heart performance to body size. This metric is crucial in evaluating cardiovascular health and guiding treatment decisions.

Chemotherapy Dosing

Perhaps the most common application of BSA outside of burn care is in oncology, where it forms the basis for calculating chemotherapy dosages. This approach helps balance treatment efficacy with potential side effects based on individual patient characteristics.

Ensuring Data Security and Compliance in Digital Burn Assessment Tools

As healthcare increasingly relies on digital tools, ensuring the security and privacy of patient data is paramount. Professional burn surface area calculators implement various measures to protect sensitive information:

Local Encryption

Patient charts are typically stored locally on devices using high-level encryption protocols. For example, many applications employ AES-256 encryption with cipher block chaining (CBC) mode and unique initialization vectors (IV) for each file.

Secure Data Handling

All collected data is encrypted and used solely for providing medical recommendations. Users are often reminded that sharing charts may not be secure and is subject to the encryption mechanisms of third-party applications used in the transfer.

Compliance Considerations

While these tools provide valuable assistance, it’s crucial to remember that all information should be verified and used only under the guidance of trained, licensed professionals. Many applications include disclaimers emphasizing this point and directing users to terms of use for more detailed information.

By implementing these security measures, burn surface area calculators strive to maintain the confidentiality and integrity of patient data while providing essential clinical support.

Customization and Flexibility in Burn Surface Area Calculators

Advanced burn surface area calculators often offer customization options to cater to diverse clinical needs and preferences:

Tailored Preferences

Users can often set default modes for chart opening, such as:

• Move mode to prevent accidental input
• Edit mode for faster data entry

These options allow healthcare providers to optimize the tool for their specific workflow.

Custom Basis Values

Many calculators allow users to input weighted basis values that align with their expertise or facility guidelines. This feature often differentiates between adult and pediatric charts, recognizing the distinct needs of these patient populations.

Flexible Calculation Methods

Users can typically choose between different calculation methods (e.g., Rule of Nines, Rule of Eights, Lund and Browder) based on the specific patient and clinical context. This flexibility ensures that the most appropriate method is used for each case.

These customization options enhance the utility of burn surface area calculators across various clinical settings and patient populations, contributing to more accurate and efficient burn assessments.

‎Surface Burn Calculator on the App Store

Record burn regions using professional editing tools. Vector-based graphics for high-precision detail. Easy, fast and simple to use. Quick Calculator for immediate Parkland results. Enhanced Rule of Nines using BMI and Rule of Eights for infants under 10 kg and adults over 80 kg using the Rule of Fives.

The Total Surface Burn Area (TBSA) is calculated from the drawn regions using the Rule of Nines, Eights, Fives or Lund and Browder. Along with the patient’s weight, height, gender, and chart-type (adult, child, infant), the Parkland Formula is used to determine an accurate amount of fluids to give the patient. Additionally, the provided Abbreviated Burn Severity Index (ABSI) can then provide an estimated mortality rate.

KEY FEATURES
Create, View, Sort, Search, Edit, and More – Unlike other calculation software, you can view and revise past records. Organize the chart list view by select fields or find results by customized title.

Quick, Efficient and Detailed Calculations – Edit quickly with simple inputs using Quick Calculate. Bypass patient measurement information to quickly draw burn regions and return to add patient details later.

Encrypted & Compliant – Patient charts are stored locally with high-level encryption.

Enhanced Rules – An available option in the application considers the latest medical studies to calculate more accurately based on BMI and body-type.

Professional Editing Tools – Use the basic Brush tool commonly seen in other software or take advantage of the Lasso tool to quickly draw the entire burn region in one motion!

Pan and Zoom! – Two-Finger-Pan, Touch-to-Pan, Pinch-to-Zoom, and more allow for precision results and faster burn region input.

Reverse-draw – Reverse side is drawn under the current view to allow the burn pattern to be matched from the anterior to the posterior.

Vector-based Graphics – Utilizing point-to-point Scalable Vector Graphics (SVG) stores the burn region as a digital value for: Better precision feedback / display, future-proofing as calculations and formulas change, and more.

Share Results – Charts are exportable using the native devices ‘Share’ feature. Subscribe or purchase individual ‘Share Charts’ items for full calculation details and advanced file-types such as PDF.

Tailored Preferences – Default opening a chart to Move mode to prevent accidental input, or default to Edit mode for faster input.

Custom Basis Values – Enter your weighted basis value that best suits your knowledge and expertise or facility guidelines. Available for adult and child/infant charts separately.

FAQs
Q. How do calculations work?
A. Anterior and Posterior body regions are divided into an average total of 35 different parts (hand, lower arm, upper arm, etc.). Each section is then combined into the respective region for display purposes (arm, leg) to give the total value for a more user-friendly view. The system then reduces and evaluates each collection of regions and determines the percentage of the clipped area that is filled-in. Each collection is then totaled and input into the Parkland Formula to determine the amount of fluids to provide.

Q. How are records stored securely?
A. Patient charts are stored locally with AES-256 using cipher block chaining (CBC) mode and a unique initialization vector (IV) which is never reused within a file, and then signed with a SHA-2 HMAC.

All data collected is encrypted and used to provide recommendations. All information displayed should be verified and only used with the assistance or advice of a trained licensed professional. Sharing charts is not secure, and is subject to the encryption mechanisms used in the transfer to the selected 3rd-party application(s).

Terms of Use: https://www.apple.com/legal/internet-services/itunes/dev/stdeula/

Body Surface Area Calculator

The calculator below computes the total surface area of a human body, referred to as body surface area (BSA). Direct measurement of BSA is difficult, and as such many formulas have been published that estimate BSA. The calculator below provides results for some of the most popular formulas.

RelatedArea Calculator | Surface Area Calculator

Table of average BSAs

BSA is often used in clinical purposes over body weight because it is a more accurate indicator of metabolic mass (the body’s need for energy). Metabolic mass can be estimated using fat-free mass, where fat-free mass is all of a person’s body mass that does not include fat. This includes bones, tendons, inner organs, muscles, blood, nerves, and more. Since body fat is not metabolically active and fat-free mass excludes body fat, fat-free mass is a reasonable estimate of metabolic mass.

BSA is also used in various other clinical settings, such as determining cardiac index (to relate a person’s heart performance to their body size) or most commonly, dosages for chemotherapy (a category of cancer treatment). While dosing for chemotherapy is often determined using a patient’s BSA, there exist arguments against the use of BSA to determine medication dosages that have a narrow therapeutic index – the comparison of the amount of a substance necessary to produce a therapeutic effect, to the amount that causes toxicity. If the therapeutic index is too narrow, BSA may not be an accurate enough measure, and there is a risk of causing a toxic rather than therapeutic effect. There is also evidence that BSA becomes less accurate at the extremes of height and weight, and BMI may be a better estimate in such cases. Despite these limitations, the effects of chemotherapy dosages as determined by BSA measurements still remain more consistent than those determined by body weight alone.

Below are some of the most popular formulas for estimating BSA, and links to references for each for further detail on their derivations. The most widely used of these is the Du Bois formula, which has been shown to be effective for estimating body fat in both obese and non-obese patients, unlike body mass index. Where BSA is represented in m², W is weight in kg, and H is height in cm, the formulas are as follows:

Du Bois formula:

BSA = 0.007184 × W^0.425 × H^{0. 725}

Du Bois D, Du Bois EF (Jun 1916). “A formula to estimate the approximate surface area if height and weight be known”. Archives of Internal Medicine 17 (6): 863-71. PMID 2520314. Retrieved 2012-09-09.

Mosteller formula:

BSA = = 0.016667 × W^0.5 × H^0.5

Mosteller RD. “Simplified calculation of body-surface area”. N Engl J Med 1987; 317:1098. PMID 3657876.

Haycock formula:

BSA = 0.024265 × W^0.5378 × H^0.3964

Haycock GB, Schwartz GJ, Wisotsky DH “Geometric method for measuring body surface area: A height-weight formula validated in infants, children and adults” J Pediatr 1978, 93:62-66.

Gehan and George formula:

BSA = 0.0235 × W^0.51456 × H^0.42246

Gehan EA, George SL, Cancer Chemother Rep 1970, 54:225-235

Boyd formula:

BSA = 0.03330 × W^{(0.6157 – 0.0188 × log10(W)} × H^0.3

Boyd, Edith (1935). The Growth of the Surface Area of the Human Body. University of Minnesota. The Institute of Child Welfare, Monograph Series, No. x. London: Oxford University Press

Fujimoto formula:

BSA = 0.008883 × W^0.444 × H^0.663

Fujimoto S, Watanabe T, Sakamoto A, Yukawa K, Morimoto K. Studies on the physical surface area of Japanese. 18. Calculation formulae in three stages over all ages. Nippon Eiseigaku Zasshi 1968;5:443-50.

Takahira formula:

BSA = 0.007241 × W^0.425 × H^0.725

Fujimoto S, Watanabe T, Sakamoto A, Yukawa K, Morimoto K. Studies on the physical surface area of Japanese. 18. Calculation formulae in three stages over all ages. Nippon Eiseigaku Zasshi 1968;5:443-50.

Schlich formula:

Women BSA = 0.000975482 × W^0.46 × H^1.08

Men BSA = 0.000579479 × W^0.38 × H^1.24

Schlich E, Schumm M, Schlich M: “3-D-Body-Scan als anthropometrisches Verfahren zur Bestimmung der spezifischen Korperoberflache”. Ernahrungs Umschau 2010;57:178-183

Burn surface area calculation: Rule 9

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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 area of ​​the affected area; the larger it is, the more insidious is the danger to the life of the victim.

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

Stretchers, spinal supports, ventilators, evacuation chairs: SPENCER PRODUCTS ON THE DOUBLE STAND AT EMERGENCY EXPO

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

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

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

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

These charts, used on admission to major burn centers, accurately display lesions on pre-printed, color-coded forms for various 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 is 1% TBSA.

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Infusion therapy for burns – Clean Clinic

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20.10.2022

Burns lead to loss of fluid, inflammation, intoxication with decay products of one’s own tissues. Without timely assistance, burn disease and shock develop. Assistance to the victim is provided as soon as possible, and infusion therapy begins even in the ambulance. On the first day, it is especially important. Next, we will talk about which drugs are used, in what volume, and at what speed they are administered.

Infusion Therapy Algorithm

On the first day, the calculation of infusion therapy for burns is carried out according to the formula:
4 ml*patient body weight (kg)*burn area (% of body surface)
If there is an inhalation injury, an additional 25% is added to this amount. The volume of infusion therapy for burns is controlled by assessing diuresis. It should be at least 0.5 ml/kg/h. Other indicators used for control:
Central venous pressure of at least 6 mm Hg. Art.;
· Mean arterial pressure should be more than 70 mm Hg. Art.;
Blood oxygen saturation – over 65%.
Half of the total volume is in Ringer’s lactate solution. It is administered in the first eight hours after the patient’s admission to the hospital. Then the rate of infusion is halved. The rest of the daily volume is administered over the next 16 hours.
Although crystalloids form the basis of infusion therapy for burn shock, the patient also needs colloids. However, they begin to be used no earlier than half a day after receiving burns. Infusion is carried out at a rate of 2 ml/kg of body weight per hour.
With burns, a person loses protein. Therefore, he is shown infusions of 10% albumin. The rate of administration depends on the area of ​​the burns. If it does not exceed 30%, then the solution is administered at a rate of 12.5 ml/h. When the area of ​​the burned body surface is less than 45%, 25 ml/h of albumin is administered, up to 60% – 37 ml/h, and if the area is even larger, then an infusion of 50 ml/h or more is carried out.
Some patients lose a lot of plasma. These patients require an infusion of fresh frozen plasma to normalize blood clotting. It is administered with a total volume of 0.8-1.5 liters, at a rate of 2 ml / kg per hour.
The adequacy of infusion therapy is monitored using the following indicators:

Infusion therapy for burns in children

In children, infusion therapy begins even at the stage of transportation to the hospital. The victim is injected with 20-40 ml / kg for 1-2 hours. Both crystalloids and colloids are used.
In hypovolemia and in very young children, peripheral vascular catheterization may be difficult. In this case, intraosseous access is used. The needle is inserted below the tibial tuberosity.