Calculating Total Body Surface Area (TBSA) is an essential step in treating patients with burns. It helps medical professionals determine the extent of the burn and the amount of fluid required for resuscitation. The TBSA is expressed as a percentage of the total body surface area affected by the burn. While there are several methods to calculate TBSA, the most commonly used ones are the Rule of Nines and the Lund-Browder chart.

The Rule of Nines is a quick and easy way to estimate TBSA in adults. It divides the body into regions that represent 9% or multiples of 9% of the total body surface area. For example, the head and neck region represent 9%, the anterior trunk region represents 18%, and each arm represents 9%. The Rule of Nines is not as accurate as the Lund-Browder chart, but it is useful in the initial assessment of patients with burns. The Lund-Browder chart is more accurate as it takes into account the age and size of the patient. It divides the body into smaller regions and assigns a percentage value to each region based on the patient's age and size.

Understanding TBSA

Total Body Surface Area (TBSA) is a medical term used to describe the percentage of the body's surface that has been affected by a burn or other injury. It is a critical factor in determining the severity of the injury and the appropriate treatment plan. TBSA is measured in percentages, with each body part assigned a specific percentage of the total body surface area.

There are several methods used to calculate TBSA, including the Rule of Nines and the Lund and Nicu Calculator Browder Chart. The Rule of Nines divides the body into sections, with each section assigned a specific percentage of TBSA. The Lund and Browder Chart is a more precise method that takes into account the varying proportions of body parts in different age groups.

Accurately determining TBSA is crucial in determining the appropriate fluid resuscitation and treatment plan for burn patients. The speed and accuracy of this initial assessment can impact the patient's healthcare journey, including transfer decisions, management, prognosis, and research.

It is important to note that TBSA is not just limited to burns; it can also be used to assess the severity of other skin injuries or diseases, such as psoriasis. Understanding TBSA is critical for medical professionals in providing the best possible care for their patients.

Methods for Calculating TBSA

Calculating the total body surface area (TBSA) affected by a burn is an essential step in determining the severity of a burn and providing appropriate treatment. There are several methods for calculating TBSA, each with its own advantages and disadvantages.

The Rule of Nines

The Rule of Nines is a quick and easy method for estimating TBSA in adults. This method divides the body into regions, each accounting for 9% or multiples of 9% of the total body surface area. The head and neck, each arm, the front and back of the torso, and each leg are each assigned a percentage based on the extent of the burn. This method is simple to use and provides a rough estimate of TBSA, but it may not be as accurate as other methods.

The Lund and Browder Chart

The Lund and Browder Chart is a more precise method for calculating TBSA, particularly in children. This method takes into account the changing proportions of a child's body as they grow. The body is divided into smaller regions, and each region is assigned a percentage based on the age of the child. This method provides a more accurate estimate of TBSA, but it can be time-consuming to use.

The Palmer Method

The Palmer Method is a simple method for estimating TBSA based on the size of the patient's palm, including their fingers. The patient's palmar surface, including their fingers, is considered to be 1% of their TBSA. This method is quick and easy to use, but it may not be as accurate as other methods.

In conclusion, there are several methods for calculating TBSA, each with its own advantages and disadvantages. The Rule of Nines is a quick and easy method, the Lund and Browder Chart is more precise, and the Palmer Method is simple and easy to use. The choice of method will depend on the patient's age, the extent of the burn, and the healthcare provider's experience and preference.

Step-by-Step Calculation Process

Calculating Total Body Surface Area (TBSA) is an important part of determining the severity of burns and planning treatment. Here is a step-by-step process for calculating TBSA:

1. 
   

   Determine the extent of the burn: The first step in calculating TBSA is to determine the extent of the burn. This is typically done using the "rule of nines" or the "Lund-Browder" chart. These methods divide the body into regions and assign a percentage value to each region based on the amount of surface area it represents.

   
   


2. 
   

   Measure the patient's weight: The next step is to measure the patient's weight in kilograms. This can be done using a scale.

   
   


3. 
   

   Measure the patient's height: The patient's height in centimeters must be measured. This can be done using a stadiometer or measuring tape.

   
   


4. 
   

   Calculate the patient's body surface area: Once the extent of the burn, weight, and height are determined, the TBSA can be calculated using a formula. One of the most commonly used formulas is the Mosteller formula:

   
   

   TBSA = (height in cm x weight in kg / 3600)^0.5

   
   

   Other formulas, such as the DuBois and Haycock formulas, can also be used.

   
   


5. 
   

   Adjust the TBSA calculation for children: When calculating TBSA for children, their body surface area is generally larger relative to their weight compared to adults. Therefore, a different formula is used to calculate TBSA for children. The most commonly used formula is the "rule of nines" modified for children.

   
   


6. 
   

   Record the TBSA calculation: Once the TBSA is calculated, it should be recorded in the patient's chart along with other relevant information such as the extent of the burn and the patient's weight and height.

   
   

It is important to note that while the above steps provide a general overview of the TBSA calculation process, medical professionals should always follow established protocols and guidelines when determining TBSA.

Factors Affecting TBSA Calculation

There are several factors that can affect the accuracy of TBSA calculation. These factors include:

Age

Age is an important factor in TBSA calculation. In general, the younger the patient, the greater the TBSA affected by a burn. This is because younger patients have a higher ratio of body surface area to body mass than older patients. Therefore, when calculating TBSA for a pediatric patient, it is important to use a chart or formula specifically designed for children.

Body Type

Body type can also affect TBSA calculation. Patients with a larger body surface area relative to their body mass will have a greater TBSA affected by a burn. This is because the burn will cover a larger area of the body. Therefore, when calculating TBSA, it is important to take into account the patient's body type.

Location of the Burn

The location of the burn can also affect TBSA calculation. Burns to certain areas of the body, such as the head, neck, and hands, are more serious than burns to other areas. This is because burns to these areas can affect the patient's ability to breathe, see, speak, or use their hands. Therefore, when calculating TBSA, it is important to take into account the location of the burn.

Depth of the Burn

The depth of the burn can also affect TBSA calculation. Burns that only affect the outer layer of skin (epidermis) are less serious than burns that affect deeper layers of skin (dermis or subcutaneous tissue). Therefore, when calculating TBSA, it is important to take into account the depth of the burn.

Other Factors

Other factors that can affect TBSA calculation include the presence of other injuries or medical conditions, the patient's overall health status, and the timing of the assessment. It is important to take these factors into account when calculating TBSA to ensure the most accurate assessment possible.

TBSA Calculation in Special Populations

Pediatric Considerations

When calculating TBSA in pediatric patients, it is important to consider that their body proportions are different from those of adults. Therefore, the traditional "Rule of Nines" method may not be as accurate in children. Instead, the Lund-Browder chart is often used, which takes into account the changing proportions of the body as the child grows. This chart divides the body into smaller regions and assigns a percentage of TBSA to each region based on the child's age.

It is also important to note that the palmar surface area of a child's hand is smaller than that of an adult, so the Palmer method of estimating TBSA may not be as accurate in pediatric patients. Instead, the child's hand can be compared to the size of a parent's hand to estimate TBSA.

Obese Patients

Obese patients present unique challenges when calculating TBSA, as their excess adipose tissue can make it difficult to accurately assess the extent of their burns. One method that has been proposed is to estimate the patient's "adjusted body weight" by subtracting a certain percentage of their excess body weight. For example, one formula suggests subtracting 25% of the excess weight for patients with a BMI of 30-39.9, and 30% for patients with a BMI of 40 or higher. This adjusted body weight can then be used to calculate TBSA using the traditional "Rule of Nines" method.

Another method that has been proposed is to use a modified Lund-Browder chart that takes into account the patient's body habitus. This chart assigns a higher percentage of TBSA to areas of the body that are typically larger in obese patients, such as the abdomen and thighs.

It is important to note that these methods are not perfect and may still result in inaccuracies when calculating TBSA in obese patients. Therefore, close monitoring of fluid resuscitation and other aspects of burn care is crucial in these patients.

Clinical Application of TBSA Data

The total body surface area (TBSA) is a crucial metric in the management of burn patients. Accurately calculating TBSA can help determine the extent of burn injury, guide fluid resuscitation, and predict complications.

One clinical application of TBSA data is in determining the need for referral to a specialized burn center. According to the American Burn Association, patients with burns involving more than 10% TBSA should be referred to a burn center for specialized care [1].

Another application of TBSA data is in guiding fluid resuscitation. The Parkland formula is commonly used to calculate fluid requirements in burn patients, with the goal of maintaining adequate perfusion and organ function [2]. The formula involves calculating the TBSA burned and administering fluid at a rate of 4 mL/kg/%TBSA burned in the first 24 hours, with half of the total volume given in the first 8 hours and the remaining half given over the next 16 hours [2].

TBSA data can also be used to predict the risk of complications, such as infection and respiratory failure. In general, the risk of complications increases with increasing TBSA burned [3].

In summary, accurate calculation of TBSA is essential in the management of burn patients. TBSA data can guide referral to specialized burn centers, fluid resuscitation, and predict the risk of complications.

References:

1. 
   

   American Burn Association. (2021). Referral Criteria. Retrieved from https://ameriburn.org/referral-criteria/

   
   


2. 
   

   Greenhalgh, D. G. (2019). Burn resuscitation. Journal of burn care -amp; research : official publication of the American Burn Association, 40(1), 1–8. https://doi.org/10.1093/jbcr/irz001

   
   


3. 
   

   Saffle, J. R. (2017). Predicting burn mortality: age, burn size, and the flip side of the coin. JAMA surgery, 152(4), 353–354. https://doi.org/10.1001/jamasurg.2016.4063

   
   

TBSA Calculation Tools and Technology

Calculating TBSA is an important step in the care of burn patients. There are several tools and technologies available to medical professionals to accurately calculate TBSA.

One commonly used tool is the "Rule of Nines," which divides the body into regions that represent 9% or multiples of 9% of TBSA. This method is simple and quick, but it may not be as accurate as other methods.

Another tool is the Palmer method, which estimates TBSA using the patient's palm size. The palmar surface of the patient's hand, including their fingers, represents 1% of TBSA. This method is easy to use and can provide a rough estimate of TBSA.

In addition to these manual methods, there are also computer programs and mobile applications available to help calculate TBSA. These tools use algorithms and image analysis to provide a more accurate calculation of TBSA. However, they may not be as widely available or accessible as manual methods.

It is important to note that while these tools and technologies can assist in TBSA calculation, they should not replace clinical judgment and assessment. Medical professionals should use their expertise and knowledge to determine the most appropriate method for each patient.

Documentation and Reporting of TBSA

Once the total body surface area (TBSA) of a burn has been calculated, it is important to document and report this information accurately. Documentation of TBSA is essential for the management of burn patients, as it helps to guide fluid resuscitation, wound care, and other aspects of treatment.

One commonly used method for documenting TBSA is the Lund-Browder chart, which provides a detailed diagram of the body surface area that is affected by the burn. This chart takes into account the differences in body proportions between children and adults, and provides a more accurate estimate of TBSA than other methods such as the Rule of Nines or the palm method.

In addition to the Lund-Browder chart, other tools may be used to document and report TBSA, such as the Surface Area Graphic Evaluation (SAGE) diagram. This tool allows the operator to manually draw in the area of burn correlating to the body part(s) involved, and then calculates %TBSA based on the Lund-Browder method. The resulting image can then be printed and incorporated into the patient's chart as part of critical documentation.

Accurate reporting of TBSA is also important for research purposes, as it helps to provide a more complete picture of the incidence and severity of burn injuries. Researchers may use TBSA data to identify trends in burn injury rates, to evaluate the effectiveness of prevention and treatment strategies, and to guide the allocation of resources for burn care.

Overall, documentation and reporting of TBSA is a critical aspect of burn care. By using accurate and reliable methods for calculating and reporting TBSA, healthcare providers can ensure that burn patients receive the appropriate treatment and care they need to recover from their injuries.

Frequently Asked Questions

What is the Rule of Nine in estimating burn extent?

The Rule of Nine is a tool used to estimate the percentage of total body surface area (TBSA) affected by burns. It divides the body into regions that represent 9% (or multiples of 9%) of the TBSA. The Rule of Nine is commonly used in adults to quickly estimate the extent of the burn injury and guide initial treatment. However, it may not be as accurate in children or patients with irregular burns.

How do you use the Lund and Browder chart for burn assessment?

The Lund and Browder chart is another tool used to estimate the TBSA affected by burns. It is more accurate than the Rule of Nine because it accounts for the differences in body surface area between adults and children. The chart divides the body into smaller regions and assigns a percentage value to each region based on the patient's age. To use the chart, the healthcare provider assesses the size and depth of the burn in each region and calculates the total percentage of TBSA affected.

How is the Parkland formula applied to calculate fluid resuscitation for burn patients?

The Parkland formula is a calculation used to determine the amount of fluid resuscitation needed for burn patients within the first 24 hours after injury. The formula recommends giving 4 mL of fluid per kilogram of body weight for each percent of TBSA burned. Half of the total volume is given in the first 8 hours, and the remaining half is given over the next 16 hours. The formula is not appropriate for patients with electrical burns or inhalation injuries.

What methods are used to calculate burn surface area in children?

In addition to the Lund and Browder chart, other methods may be used to estimate TBSA in children. The most common method is the "rule of palm," which estimates the size of the patient's hand as 1% of TBSA. The "rule of nines" can also be used in children, but it may overestimate the TBSA in young children due to differences in body proportions.

How is total burn surface area (TBSA) determined for irregular burns?

For irregular burns, such as those that do not fit the standard body regions used in the Rule of Nine or Lund and Browder chart, the healthcare provider may estimate the TBSA by comparing the size of the burn to the size of the patient's palm. Each palm is approximately 1% of TBSA.

What are the steps to assess the percentage of a burn injury?

To assess the percentage of a burn injury, the healthcare provider first determines the depth of the burn and the TBSA affected. This can be done using the Rule of Nine, Lund and Browder chart, or other methods. The healthcare provider then calculates the total percentage of TBSA affected and uses this information to guide initial treatment, such as fluid resuscitation and wound care.