What is the best method to estimate body surface area affected by burns in a pediatric patient?

Pediatric Burn Percentage Assessment

Primary Recommendation

Use the Lund-Browder chart as the standardized method for calculating total body surface area (TBSA) in pediatric burn patients, as it is specifically designed to account for age-related variations in body proportions and provides the most accurate assessment. 1, 2

Why the Lund-Browder Chart is Essential for Children

The Lund-Browder chart (pediatric version) is the reference standard because it accounts for the critical anatomical differences in children compared to adults 1, 2:

• Children have proportionally larger heads and smaller lower extremities, making adult-based methods highly inaccurate 2
• The chart adjusts body surface area percentages based on age groups, providing age-specific accuracy 3
• The Rule of Nines significantly overestimates TBSA and is NOT suitable for children 1, 2

Practical Implementation

In Hospital Settings

• Use the standardized Lund-Browder chart with pediatric age adjustments as your primary tool 1, 2
• Perform repeated assessments during the first hours of care, as initial TBSA estimates are frequently inaccurate 2
• Consider smartphone applications (E-Burn, FireSync EMS, 3D PED BURN) to facilitate more accurate calculation and reduce overestimation bias 1, 2, 3, 4

In Prehospital or Emergency Settings

When the Lund-Browder chart is impractical, use these alternative methods 1, 2:

• The entire palmar surface of the hand (palm AND fingers) = approximately 1% TBSA 2, 5
• The palm alone represents only 0.5% TBSA, so do not use palm-only estimates 2, 5
• The serial halving method can be used in mass casualty situations 1

Critical Pitfalls to Avoid

Do not use the Rule of Nines for pediatric patients - this method fails to account for children's proportionally larger head and smaller lower extremities, leading to systematic overestimation in 70-94% of cases 1, 2:

• Overestimation leads to excessive fluid administration and potential complications including compartment syndrome 1, 2
• TBSA overestimation triggers inappropriately aggressive interventions with potential for patient harm 6

Do not rely on visual estimation alone - standardize your assessment using the Lund-Browder chart integrated into your transfer and documentation process 6

Age-Specific Considerations

Modern 3D applications have developed models categorized into specific pediatric age groups 3:

• <1 year
• 1-4 years
• 5-9 years
• 10-15 years

These age-based models account for weight, height, and body size variations within each age group 3

Quality Improvement Strategy

To improve consistency between referring facilities and burn centers 6:

• Use a standardized Lund-Browder form integrated into the interfacility transfer process
• Document TBSA in >90% of transfer cases
• Aim for <15% clinically significant discrepancies (>5% difference) between assessments