Determining Burn Severity
ON THIS PAGE
Causes of Burn Injuries
Methods for Evaluating % Total Body
Surface Area (TBSA)
Severity of burn injury is determined by the depth of injury, extent of body surface injured, location of burn on the body, age of the patient, pre-burn medical history and circumstances or complicating factors (e.g., smoke inhalation, other traumatic injuries).
Contact with hot surfaces
(iron, stove, portable heaters, radiators, metal surfaces heated by the sun)
(hot liquids or steam)
Burn Depth: How Deep Is the Burn?
First Degree (Superficial):
Damage to the skin is limited to the outer layer (epidermis). The skin is intact and typically appears to be pink/red in color, very warm or hot to touch and painful. Swelling and small blisters may be present. A common cause of first degree burns is sunburn.
Third Degree (Full Thickness):
All three layers of the skin (epidermis, dermis, and hypodermis/subcutaneous tissue) are damaged; the injury can include deep penetration into muscles, organs and bones. The affected area is dry, leathery and may present in many colors (e.g., whitish, charred or tan-colored). Due to nerve destruction, full-thickness areas are non-sensate (i.e., have loss of feeling/sensation).
Second Degree (Partial-Thickness):
Damage to the skin includes the outer layer and penetrates to the middle layer of tissue (dermis). The wound is typically moist/wet and red; swelling is usually present; there may be blisters or sloughing (loss) of skin; it is very painful.
Burn Size: How Big Is the Burn?
When managing a burn patient, it is important to estimate the percentage of total body surface area (TBSA) that has been burned. When estimating %TBSA, only partial and full-thickness (second and third-degree) injured areas are included in the estimate.
Two Methods for Evaluating %TBSA:
The Rule of 9's
Estimates the %TBSA burned by dividing the body into regions, each region representing approximately 9% TBSA or multiples of 9%. The genitals represent 1%. To account for their proportionally larger-sized heads, infants and children have a slightly different percentage rating per body region.
The Palmar Method
For scattered or small burn injury areas, the burned patient’s FULL HAND (including fingers) may be used to approximate 1% TBSA, regardless of age. However, its usefulness is isolated to up to 10% TBSA.