Topic Five: Burn Size
Determining the Size
Accurate estimation of the surface area and depth of a burn is essential for determining appropriate management to ensure healing and prevention of complications. Total burn area is expressed as a percentage of the total body surface area (TBSA) and is vital for establishing fluid resuscitation needs and monitoring healing progression.
The seriousness of a burn is assessed by looking at the burn surface area as well as the patient’s health and age. To estimate the percentage of the body that has been burnt, both the Rule of Nines (Wallace, 1951) and the Lund-Browder system are used.
The Rule of Nines
The Rule of Nines is a quick and effective way when estimating the surface area affected by a burn. This method allows for a quick gross estimate for adult patients. The Rule of Nines is mainly used on initial assessment on arrival to the emergency department.
The Lund-Browder System
The Lund and Browder (1944) chart is used for a more accurate assessment of a patient’s burns as it compares the areas affected to the percentage of the total area. The Lund–Browder system is especially used in burns >10% in children and >15% in adults. This method also considers the age of the patient.
| At Birth | 0-1 Year | 1-4 Years | 5-9 Years | 10-15 Years | Adult | |
|---|---|---|---|---|---|---|
| A = Front or back of head | 9.5% | 8.5% | 6.5% | 5.5% | 4.5% | 3.5% |
| B = Front or back of thigh | 2.75% | 3.25% | 4% | 4.25% | 4.5% | 4.75% |
| C = Front or back of leg | 2.5% | 2.5% | 2.75% | 3% | 3.25% | 3.5% |
The Lund-Browder (1944) system not only divides the body into smaller areas but also considers the age of the patient. As the body proportions alter during childhood, the front of the head of a one-year-old child is 8.5% of the whole body but only 4.5% of the whole body in a 15-year-old.