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Burns Percentage Surface Area

Following first aid measures, it is important to be able to assess the burn and determine the percentage surface area that is affected. This percentage or area determines what fluid resuscitation is needed in hospital, and whether the child needs to be admitted. It is important to be as accurate as possible, and the following systems are used for assessment in adults and children.

The most important part to remember is NOT to include the areas of burnt skin which is just red and erythematous, as this area does not affect the structure of the skin, as it isn’t broken, and therefore should not be included in the estimation.

There are many helpful tools for estimation of surface area. We have included a really useful image for this purpose, downloadable at the bottom of this page in pdf form.

Other methods of assessing percentage burns include the following:

Lund and Browder Chart

This takes into account the percentage area of each segment of the body, and allows easy estimation of affected area by drawing on the affected area. Children have different body segment percentages, which change with age due to having relatively large heads, and short limbs initially.

Mersey Burns App

This app on your phone, allows you to colour in the areas affected and calculates a percentage for you. It helpfully corrects for age and size if you put the data in.

General Rule

As a rough measure, the child’s palm and finger surface area of one hand (not the examiner’s) represents 1% TBSA – and this applies to everyone, adults and children. Hence it’s the patient’s palm that is used for estimation.

Assessment of Depth of Burn

Burns depth assessment may be difficult, especially in the acute phase when the skin is red and the child is very upset.

The table below aids accurate estimation of burn depth, which is important for further management in hospital.

Depth Cause Surface/Colour Pain Sensation
Superficial Sun, flash, minor scald Dry, minor blisters, erythema, brisk capillary return Painful
Superficial Partial thickness -(superficial dermal) Scald Moist, reddened with broken blisters, brisk capillary return Painful
Deep Partial thickness -     (deep dermal) Scald, minor flame contact Moist white slough, red mottled, sluggish capillary return Painless
Full thickness Flame, severe scald or flame contact Dry, charred whitish. Absent capillary return Painless

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This article is from the free online course:

Emergency and Urgent Care for Children: a Survival Guide

University of Birmingham