Abstract
In burn medicine, the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA) is a crucial parameter to ensure adequate treatment and therapy. Inaccurate estimations of the burn extent can lead to wrong medical decisions resulting in considerable consequences for patients. These include, for instance, over-resuscitation, complications due to fluid aggregation from burn edema, or non-optimal distribution of patients. Due to the frequent inaccurate TBSA-B estimation in practice, objective methods allowing for precise assessments are required. Over time, various methods have been established whose development has been influenced by contemporary technical standards. This article provides an overview of the history of burn size estimation and describes existing methods with a critical view of their benefits and limitations. Traditional methods that are still of great practical relevance were developed from the middle of the 20th century. These include the “Lund Browder Chart”, the “Rule of Nines”, and the “Rule of Palms”. These methods have in common that they assume specific values for different body parts’ surface as a proportion of the TBSA. Due to the missing consideration of differences regarding sex, age, weight, height, and body shape, these methods have practical limitations. Due to intensive medical research, it has been possible to develop three-dimensional computer-based systems that consider patients’ body characteristics and allow a very realistic burn size assessment. To ensure high-quality burn treatment, comprehensive documentation of the treatment process, and wound healing is essential. Although traditional paper-based documentation is still used in practice, it no longer meets modern requirements. Instead, adequate documentation is ensured by electronic documentation systems. An illustrative software already being used worldwide is “BurnCase 3D”. It allows for an accurate burn size assessment and a complete medical documentation.
Highlights
An accurate assessment of both the burn depth and the burn extent is essential for adequate and successful treatment
In addition to the depth of a burn injury, the burn extent is the second important criterion to be assessed to determine adequate treatment methods. The latter is defined as the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA), whereby first-degree burns are excluded
The initial fluid therapy in the first 24 h should consist of isotonic crystalloid with a volume between 2 and 4 mL/kg/TBSA-B and should be titrated to ensure the urinary output of 30–50 mL/h [6]
Summary
An accurate assessment of both the burn depth and the burn extent is essential for adequate and successful treatment. Whereas the first type involves damage to the epidermis and the superficial dermis, with blisters, a rosy and recapillarizing wound base, severe pain, and firmly anchored hair, the second type is characterized by injuries to the deep dermis and skin appendages. Burns healing within one week are categorized as “first-degree” or “superficial” burns; those healing within two weeks are referred to as “second-degree superficial” or “superficial partial thickness” burns. In addition to the depth of a burn injury, the burn extent is the second important criterion to be assessed to determine adequate treatment methods. The latter is defined as the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA), whereby first-degree burns are excluded. Both burn depth and burn extent are important criteria in burn medicine, the scope of this paper is limited to the assessment and documentation of burn extent
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