Burn Size

The size of a burn injury is quantified as the percentage of body surface area (BSA) involved. 7 One method of calculating the percentage of BSA burned is to use the rule of nines (Fig 194-1). This method divides the body into segments that are approximately 9 percent or multiples of 9 percent, with the perineum forming the remaining 1 percent. In infants and children, this method must be modified because of their larger heads and smaller legs.

FIG. 194-1. Rule of nines to estimate percentage of burn.

Another method is based on the fact that the area of the back of a patient's hand is approximately 1 percent BSA. The number of "hands" that equal the area of the burn can approximate the percentage of BSA burned.

A more precise estimation of the percentage of BSA burned is obtained by using a Lund and Browder burn diagram ( Fig 194-2). This allows for accurate determination of the size and depth. These charts are age-adjusted, hence allowing for changes in children at different ages.

FIG. 194-2. Lund and Browder diagram to estimate percentage of pediatric burn.

Experienced burn-care nurses and physicians are reliable in estimating burn size regardless of the method used. 8 However, it is common for inexperienced individuals to estimate burn size incorrectly when patients are first assessed in the ED.

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