Learning Objectives
The objectives of this talk are to help you gain a better understanding of the depths of burns, how to quantify the burn injury, and how those factors will affect your role as a therapist. We will also discuss proper positioning to prevent scar contracture and scar management techniques.
Burn Severity
There are several factors to consider when determining burn severity. When reviewing the patient’s chart, look for information about the size and depth of the burn. Most people are familiar with the categories of first, second and third degree burns. However, burn depth is quantified differently in the medical record and instead uses terms such as superficial, superficial partial thickness, deep partial thickness to full thickness burn. The type or cause of the burn is also important to know. Was the burn caused by contact with a hot object versus a scald from hot oil versus a friction burn? This information can help in preparation for what you will encounter during the initial assessment. Other factors that contribute to severity of a burn include the patient’s age, whether they have a supportive home environment, and whether they have any broken bones or other cumulative trauma or comorbidities. These factors play a part in how that patient is going to recover.
Size of Burn
The size of the burn is determined by calculating the total body surface area (TBSA) of the burn. In Figure 1 below, the first diagram on the left shows one method of calculating the TBSA for an adult based on the Wallace rule of nines. All of the percentages are a derivative of nine because it divides the body into 11 areas, each estimated to make up nine percent. This is one of the original methods for calculating the percentage of total body surface area and is a quick way to figure out the size of the burn.
It is important to know that the Wallace rule of nines is not accurate for use with children, actually anyone age fourteen years or younger. In Figure 1, the four diagrams on the right depict the Lund and Browder chart which takes into consideration how the body proportions change throughout childhood. You can see that the body areas are quantified a bit differently from infant through fourteen years, which provides a more accurate assessment of the size of the burn in pediatric patients. This is not an assessment that therapists calculate, but it gives important information about how involved the patient is and their risk of infection.
