What are the criteria for classifying burns?

Burn Classification System

Burns are classified based on depth of tissue involvement, with additional consideration for total body surface area (TBSA) affected and other risk factors to determine severity and appropriate management.

Classification by Depth

• Superficial (First-Degree) Burns

  • Involve only the epidermis 1
  • Characteristics: painful, red, dry, no blisters, blanch with pressure 1
  • Healing time: 3-5 days without scarring 1, 2
  • Example: Mild sunburn 2

• Partial-Thickness (Second-Degree) Burns

  • Superficial Partial-Thickness

    • Involve epidermis and upper dermis 1, 3
    • Characteristics: painful, moist, blisters, pink to red base, blanch with pressure 1
    • Healing time: 1-3 weeks, minimal scarring 1

  • Deep Partial-Thickness

    • Involve epidermis and deeper dermis 1, 3
    • Characteristics: less painful (damaged nerve endings), white to yellow appearance, less moisture 1
    • Healing time: >3 weeks, significant scarring risk 1
    • Require immediate referral to burn surgeon 1

• Full-Thickness (Third-Degree) Burns

  • Involve entire dermis 1, 3
  • Characteristics: dry, leathery, waxy white to charred appearance, painless (destroyed nerve endings) 1
  • No spontaneous healing, require surgical intervention 1
  • Require immediate referral to burn center 1

Measuring Burn Surface Area

• Lund and Browder Chart is the recommended standardized method for measuring TBSA for both adults and children 4
• Alternative methods:
  • Rule of Nines (less accurate, not suitable for children) 4
  • Palm method: patient's palm (including fingers) represents approximately 1% of their TBSA 4

Criteria for Severe Burns Requiring Specialized Care

Adults

• TBSA burned >20% or deep burns >5% 4
• Burns involving face, hands, feet, perineum, or flexure lines 4, 5
• Inhalation injury 4
• Electrical or chemical burns 4
• TBSA <20% WITH any of:
  • Age >75 years 4
  • Severe comorbidities 4
  • Circular burns 4

Children

• TBSA >10% or deep burns >5% 4
• Age <1 year 4
• Burns involving face, hands, feet, perineum, or flexure lines 4
• Circular burns 4
• Electrical or chemical burns 4
• Severe comorbidities 4
• Inhalation injury 4

Initial Management Based on Classification

• Superficial Burns

  • Cool with running water for 10-20 minutes 4, 5
  • OTC pain medications 5
  • Moisturizers or petrolatum-based products 5

• Partial-Thickness Burns

  • Cool with running water for at least 10 minutes 4
  • Cover with clean, non-adherent dressing 4, 5
  • Seek medical attention if involving critical areas or exceeding 10% TBSA (5% in children) 4, 5

• Full-Thickness Burns

  • Require immediate medical attention 4, 1
  • Cover with clean, dry, non-adherent dressing while awaiting medical care 5

Common Pitfalls to Avoid

• Do not apply ice directly to burns; it can cause tissue ischemia 4
• Do not break blisters as this increases infection risk 4, 5
• Do not apply butter, oil, or other home remedies 6, 5
• Do not delay seeking medical attention for burns with blistering or broken skin 6
• Avoid natural remedies except in remote settings where commercial products are unavailable 4

Long-Term Complications

• Pruritus 1
• Hypertrophic scarring 1
• Permanent hyperpigmentation 1
• Functional limitations with deep burns 4

By accurately classifying burns and following appropriate management protocols, healthcare providers can optimize outcomes and minimize complications for burn patients.