Accuracy of Currently Used Paper Burn Diagram vs a Three-Dimensional Computerized Model

Abstract

Burn units have historically used paper diagrams to estimate percent burn; however, unintentional errors can occur. The use of a computer program that incorporates wound mapping from photographs onto a three-dimensional (3D) human diagram could decrease subjectivity in preparing burn diagrams and subsequent calculations of TBSA burned. Analyses were done on 19 burned patients who had an estimated TBSA burned of ≥20%. The patients were admitted to Shriners Hospitals for Children or the University of Texas Medical Branch in Galveston, Texas, from July 2012 to September 2013 for treatment. Digital photographs were collected before the patient's first surgery. Using BurnCase 3D (RISC Software GmbH, Hagenberg, Austria), a burn mapping software, the user traced partial- and full-thickness burns from photographs. The program then superimposed tracings onto a 3D model and calculated percent burned. The results were compared with the Lund and Browder diagrams completed after the first operation. A two-tailed t-test was used to calculate statistical differences. For partial-thickness burns, burn sizes calculated using Lund and Browder diagrams were significantly larger than those calculated using BurnCase 3D (15% difference, P < .01). The opposite was found for full-thickness burns, with burn sizes being smaller when calculated using Lund and Browder diagrams (11% difference, P < .05). In conclusion, substantial differences exist in percent burn estimations derived from BurnCase 3D and paper diagrams. In our studied cohort, paper diagrams were associated with overestimation of partial-thickness burn size and underestimation of full-thickness burn size. Additional studies comparing BurnCase 3D with other commonly used methods are warranted.

Figure 1.

Representative photograph-assisted tracing in BurnCase 3D. A. The posterior torso of a 14-year-old female is shown, superimposed onto a properly fitted and positioned 3D model. B. Partially complete tracing of the burn injury using the photograph as a reference. C. Completed tracing of the burn injury. D. Final depiction of the burn injury to the posterior torso shown on the 3D model alone.

Figure 2.

Difference in percent burn obtained using Lund and Browder diagrams and BurnCase 3D. Differences are shown for full-thickness burns (Full; −11 ± 5%), partial-thickness burns (Partial; 15 ± 5%), and TBSA burns (4 ± 2%). Data are presented as the mean ± SEM (%).

Figure 3.

Absolute difference in percent burn obtained using Lund and Browder diagrams and BurnCase 3D. Differences are shown for partial-thickness burns (Partial; 18 ± 4%), full-thickness burns (Full; 17 ± 4%), and TBSA (6 ± 1%). Data are presented as the mean ± SEM (%).