Calculating Burn Body Surface Area (BSA) Percentage
The Lund-Browder chart is the recommended standardized method for calculating burn BSA percentage in both adults and children, as it provides the most accurate TBSA quantification. 1
Primary Assessment Method: Lund-Browder Chart
Use the Lund-Browder chart as your primary tool for TBSA calculation because it accounts for age-related variations in body proportions and has been validated as the most accurate method available. 1, 2
Why Lund-Browder is Superior:
- The Wallace Rule of Nines significantly overestimates TBSA (in 70-94% of cases) and is not suitable for children. 1
- Accurate TBSA measurement is critical because overestimation leads to excessive fluid administration during resuscitation, while underestimation increases morbidity and mortality. 1
- The Lund-Browder method should be repeated during initial management as burn appearance evolves. 2
Alternative Methods for Specific Situations
For Prehospital or Mass Casualty Settings:
The serial halving method or the open hand method (palm plus fingers = 1% TBSA) can be used when the Lund-Browder chart is impractical. 1
- The entire palmar surface of the hand (palm and fingers) represents approximately 1% TBSA, while the palm alone represents only 0.5% TBSA. 1, 3
- This hand method is simple to teach, easy to use, and limits TBSA overestimation. 1
Technology-Assisted Options:
Smartphone applications (such as E-Burn or EasyTBSA) can facilitate accurate TBSA assessment and have demonstrated superior accuracy compared to traditional methods. 1, 4
Critical Measurement Technique
Record the extent of epidermal detachment separately from erythema on a body map using the Lund-Browder chart. 1
- Detachment should include both detached epidermis AND detachable epidermis (Nikolsky-positive areas). 1
- The amount of epidermal detachment, not erythema, has prognostic value for mortality risk. 1
Common Pitfalls to Avoid
- Do not use the Rule of Nines for children as it fails to account for their proportionally larger head and smaller lower extremities. 1
- Do not rely on erythema alone for TBSA calculation in severe burns—measure actual epidermal detachment. 1
- Be aware that the Rule of Nines overestimates head and arm contributions while underestimating trunk and leg contributions across all body mass index groups. 5
- Perform repeated assessments during the first hours of care, as initial TBSA estimates are often inaccurate. 1
Body Mass Index Considerations
For obese patients, standard methods introduce significant errors. 5 A modified approach assigns:
- Head: 5% TBSA (all BMI groups)
- Arms: 15% TBSA (all BMI groups)
- Trunk/legs: normal-weight 35/45%, obese 40/40%, morbidly obese 45/35% 5