How to accurately estimate burn size to ensure proper patient care

Mis-estimation results in over or under-transfer to burn centers, inappropriate patient treatment, unnecessary healthcare costs, and miscalculations of IV fluid volume needed for burn resuscitation.

Since its introduction in 1951, the “Rule of Nines” has offered a straightforward way to estimate burn sizes, and it continues to be widely used today. However, the Lund-Browder chart introduced in 1942 is seen as more accurate. The most current version breaks the body into 19 regions. The Lund Browder chart was first developed based on body surface calculations fitting 99.9% of the population in 1935. 

However, those calculations are questionably no longer accurate because none of the charts take into consideration the current obesity epidemic and resultant increase in body sizes. Although adjusted values are suggested to account for this discrepancy, they are seldom utilized, leading to significant underestimations of burn size for the torso, arms, and legs in obese patients.

Another interesting detail is that the burn charts underestimate the size of anterior torso burns in large-breasted individuals. Bra cup size has been directly correlated to anterior torso surface area.