Lund and Browder Chart for Pediatric Burn Assessment
The Lund and Browder chart is the recommended standardized method for calculating total body surface area (TBSA) burned in pediatric patients, as it accounts for age-related variations in body proportions and provides the most accurate TBSA quantification. 1, 2
Why Lund and Browder is Essential for Children
The Rule of Nines should never be used in pediatric patients because it fails to account for children's proportionally larger head and smaller lower extremities, leading to significant estimation errors. 2
The Lund and Browder chart is specifically designed with age-adjusted body surface area percentages that reflect the anatomical differences between infants, children, and adults. 1, 3
This method has been validated as the most accurate tool available for TBSA calculation across all age groups, with superior performance compared to other estimation methods. 2
How to Use the Chart Properly
Select the age-appropriate Lund and Browder diagram that corresponds to your patient's age group (typically categorized as: <1 year, 1-4 years, 5-9 years, 10-15 years, and adult). 1
Map the burned areas onto the body diagram, calculating the percentage for each anatomical region based on the age-specific values provided on the chart. 1, 3
Record the extent of epidermal detachment separately from erythema on the body map—the amount of epidermal detachment (not just redness) has prognostic value for mortality risk. 2
Include both detached epidermis AND detachable epidermis (Nikolsky-positive areas) in your measurement. 2
Alternative Methods When Chart is Unavailable
If the Lund and Browder chart is impractical in the field, use the patient's entire palmar surface (palm plus fingers) as approximately 1% TBSA for quick estimation. 2, 3
The palm alone represents only 0.5% TBSA, so ensure you include the fingers when using this method. 2
Critical Pitfalls to Avoid
TBSA is overestimated in 70-94% of cases, particularly in pediatric patients and with smaller burns, leading to excessive fluid administration and potential harm. 2, 4
Perform repeated assessments during the first hours of care, as initial TBSA estimates are frequently inaccurate and burns evolve in appearance over the first few days. 2, 4
Be especially conservative when estimating burns in children—overestimation can trigger unnecessarily aggressive interventions including inappropriate transfer to burn centers and fluid overload during resuscitation. 5, 6
Ensure the standardized Lund and Browder form is integrated into your interfacility transfer process to improve consistency between referring facilities and burn centers. 6
Modern Technology Options
Smartphone applications (such as FireSync EMS, 3D PED BURN, or EasyTBSA) can facilitate more accurate TBSA calculation and reduce overestimation bias compared to manual Lund and Browder chart use. 2, 5, 7, 8
These digital tools have demonstrated superior accuracy, particularly for pediatric patients and burns of varying sizes, with lower inter-rater variance. 5, 7, 8