What is the total body surface area (TBSA) of the patient's burns?

Calculation of Total Body Surface Area (TBSA) for Burn Patient

The total body surface area (TBSA) of the patient's burns is approximately 18% based on the Lund-Browder method, which is the most accurate way to measure burn surface area in both adults and children. 1

Burn Areas Identified

• Anterior trunk: approximately 13% TBSA
• Right arm: approximately 5% TBSA
• Total: 18% TBSA

Method Selection for TBSA Calculation

The Lund-Browder chart is the recommended method for calculating TBSA in burn patients for several important reasons:

• It is considered the most accurate method for TBSA quantification 1
• It is suitable for both adults and children, unlike the Wallace rule of nines 1, 2
• It accounts for the different proportions of body parts at different ages 3

Alternative Methods and Their Limitations

1. Wallace Rule of Nines:

   • Tends to significantly overestimate TBSA 1
   • Not suitable for children 1, 3
   • Less accurate than Lund-Browder method 2

2. Palm Method:

   • Patient's palm and fingers represent approximately 1% of TBSA 1
   • Useful for quick estimates in prehospital settings
   • May be less accurate for precise calculations

3. Digital Applications:

   • Apps like EasyTBSA and E-Burn can improve accuracy 4, 5
   • EasyTBSA showed the greatest accuracy (-0.01%, SD 3.59%) in a recent validation study 4
   • These applications can be particularly helpful for clinicians with less burn experience 5

Clinical Implications of TBSA Calculation

Accurate TBSA estimation is critical because:

• It determines fluid resuscitation requirements 6
• Inaccurate estimation (particularly overestimation) can lead to:
  • Fluid overload during resuscitation 6, 7
  • Unnecessary transfers to burn centers 7
  • Increased resource utilization 1

Common Pitfalls in TBSA Estimation

• TBSA is overestimated in 70-94% of cases 1
• Burns between 10-19.9% TBSA are most frequently overestimated 7
• Overestimation by referring institutions can be as high as 44% TBSA 7
• Lack of experience with burn assessment leads to greater variance in estimates 5

Burn Severity Assessment

Based on the 18% TBSA calculation, this patient's burn is considered moderate to severe, requiring:

• Careful monitoring
• Appropriate fluid resuscitation
• Consideration for transfer to a burn center based on:
  • 18% TBSA (close to the 20% threshold for adults) 2
  • Presence of blisters indicating partial-thickness burns
  • Severe pain (9/10)

Next Steps in Management

1. Specialist Consultation: Contact a burn specialist to determine if transfer to a burn center is warranted 1
2. Pain Management: Implement multimodal pain control for severe pain (9/10) 2
3. Fluid Resuscitation: Calculate fluid requirements based on the 18% TBSA
4. Wound Care: Clean wounds and apply appropriate dressings 2
5. Monitoring: Watch for signs of compartment syndrome or respiratory compromise 2

Accurate TBSA calculation using the Lund-Browder method is essential for appropriate management of this 25-year-old woman with burns to her anterior trunk and right arm.