Appraising current methods for preclinical calculation of burn size - A pre-hospital perspective

Abstract

Background: Calculation of the percentage of total body surface area burnt is a vital tool in the assessment and management of patients sustaining burns. Guiding both treatment and management protocols. Currently there is debate as to which method of estimation is the most appropriate for pre-hospital use.

Methods: A literature review was undertaken to appraise current literature and determine the most appropriate methods for the pre-hospital setting. The review utilised MEDLINE and structured hand searching of Science Direct, OpenAthens, COCHRANE and Google Scholar.

Results: Fourteen studies were identified for review comparing various methods. The palm including digits was identified to represent 0.8% of total body surface area with the palm excluding digits representing 0.5%. Wallace's Rule of Nines was found to be an appropriate method of estimation. Variation in accuracy is accountable to expertise, experience and patients body type however current technology and smartphone applications are attempting to counter this.

Conclusions: Palm including digits measurements multiplied by 0.8 is suitable for assessing minor (<10%) burns however for larger burns Wallace's Rule of Nines is advocated. Further development of technology suggests computerised applications will become more commonplace.

Keywords: Burn calculation; EMS; Paramedic; Pre-hospital; Rule of Nines; Rule of Palms.