Is Palmar Surface Area a Reliable Tool to Estimate Burn Surface Areas in Obese Patients?

Butz, Daniel R.; Collier, Zachary J; O’Connor, Annemarie; Magdziak, Megan; Gottlieb, Lawrence J.

doi:10.1097/bcr.0000000000000146

Cited by 14 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, if the standard was shifted from 1% to 0.8%, the RP would likely still show discrepancies because not all patients' palm surface area percentage (%PSA) matches the average 0.8% due to anthropometric variation. For example, studies have shown a significant difference in PSA in patients with different BMI, where a higher BMI correlates with a lower %PSA (Butz et al, 2015). While this study presents a subjective understanding of how %PSA changes with varying BMI, it uses formulas to estimate TBSA, which introduces error in the calculations.…”

Section: Related Workmentioning

confidence: 99%

“…Traditionally, the primary methods applied to assess the BBSA have been the Lund-Browder burn chart (LBC), rule of nines (RN), and rule of palm (RP), used alone or in any combination. Various studies have shown significant errors in each of these approaches (Amirsheybani et al, 2001;Hammond and Ward, 1987;Butz et al, 2015;Giretzlehner et al, 2013;Haller et al, 2012;Berry et al, 2001). In addition, most patients do not experience burns in full segments of the body, but rather in multiple partial segments.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A quantitative assessment of variations in the palm surface area as a percentage of total body surface area within the general population

Liu¹,

Bhatt²,

Farrell³

et al. 2018

IJHFMS

View full text Add to dashboard Cite

Healthcare professionals who treat burn patients determine fluid requirements for resuscitation based on an estimation of burned body surface area (BBSA) as a percentage of total body surface area (TBSA). Hence, it is important to get an accurate assessment of these values. An overestimation or underestimation of the BBSA percentage can lead to medical complications, negatively affecting a patient's quality of care. Conventional methods to estimate the BBSA percentage include segmenting the three dimensional body surface into a two-dimensional burn chart or estimating the area relative to the palm of the hand with the assumption that the palm represents 1% of the TBSA. These methods introduce inaccuracies due to unreliable assumptions and estimations. For example, methods that rely on a burn chart overgeneralise that the body type of a patient to fit the established body sections in the chart, and methods that use the palm of the hand rely on incorrect assumptions regarding the palm surface area. This paper demonstrates specifically that the assumption that a patient's palm can be estimated as 1% of the TBSA is not reliable. In addition, it summarises, evaluates, and quantifies these inaccuracies, and compares and contrasts the variations for different genders.

show abstract

Section: Related Workmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A quantitative assessment of variations in the palm surface area as a percentage of total body surface area within the general population

Liu¹,

Bhatt²,

Farrell³

et al. 2018

IJHFMS

View full text Add to dashboard Cite

show abstract

“…When using the Rule of Palm, the injuries are overestimated as the relative palmar surface area decreases when BMI increases due to changing body proportions. 7 , 32 It can be difficult to calculate the body surface area in obese patients; the DuBois-DuBois formula, which is described to be more accurate for the obese population, can be used for this purpose. 30 Other studies suggest that using a 3D scanner to measure the body surface area in the obese population is much simpler than other methods.…”

Section: Discussionmentioning

confidence: 99%

“…Body proportions according from Rule of Nines, adapted from Knaysi et al5 Classification of BMI, adapted from Butz et al32 …”

mentioning

confidence: 99%

Does the estimation of burn extent at admission differ from the assessment at discharge?

Holm

Engström

Petäjä

et al. 2021

Scars, Burns & Healing

View full text Add to dashboard Cite

Introduction: Estimation of total body surface area (TBSA) burnt and burn depth are among the most central parts of acute burn assessment/treatment as they determine the level and type of care needed. Traditional methods for determining burn extent on admission often lead to inaccurate estimations, especially in paediatric or overweight patients. Aim: To compare %TBSA at admission with validated %TBSA at discharge in different patient populations to investigate if significant over- or underestimation occurs. Method: This retrospective observational study is based on a patient registry of all the patients (n = 863) treated at the Uppsala University Hospital’s Burn Centre between 2010 and 2018. The patients were divided into subgroups based on age, gender, body mass index (BMI) and validated burn extent. The %TBSA estimated at admission was compared to the validated %TBSA in all groups separately. Results: As has been published before, we also found that the %TBSA in paediatric patients was more often overestimated as were the smaller injuries, whereas larger injuries were often underestimated. BMI did not clearly affect the estimations and there was no clear difference between the genders in estimated %TBSA. Conclusion: Inaccurate estimations of %TBSA are common, particularly for paediatric patients and small or large injuries. We recommend a careful accurate approach when calculating %TBSA in the paediatric population to avoid over- and under-resuscitation. Increased education and training are recommended to improve accurate estimation in the future. Lay Summary The correct estimation of both extent and depth of burn is very important. This assessment guides the lever of care needed, the necessary amount of fluid resuscitation, the predicted outcome and more. It has been proven notably difficult to correct assess, especially the extent of a burn. Despite different tools as the “Rule of Nine” (body area divided into multiples of 9% body surfaces), the “Rule of Palm” (Patient’s palm, fingers included, approximates 1% of body surfaces), the Lund & Browder chart (detailed, age-specific body areas) and different more technical solutions. Often inaccurate estimations are done which thus affect the treatment. This depth and extent estimation is usually performed when the patient is admitted. However, it is known that burns change appearance during the first few days of care. In our Burn Center we have also performed this estimation when the patient is discharged. At this point it is known the true extent and depth of the initial burn. In this retrospective observational study, we compared the burn extent estimated on admission with the one on discharge to investigate whether the initial assessment is accurate. This study highlights the issue of frequent inaccurate burn extent estimations, especially in subgroups as overweight patient or pediatric patients.

show abstract

“…However, both models were derived from a century-old formula based on papier-mâché molds of 12 individuals aged 21 months to 43 years . Many studies report inaccuracy and poor interrater reliability of existing %TBSA burn estimation models, especially for patients with obesity . Both the Lund-Browder chart and rule of nines assume a singular physique applies for all adults and do not account for the modern population’s wide spectrum of body habitus.…”

Section: Introductionmentioning

confidence: 99%

Practical Computer Vision Application to Compute Total Body Surface Area Burn

et al. 2022

View full text Add to dashboard Cite

IMPORTANCECritical burn management decisions rely on accurate percent total body surface area (%TBSA) burn estimation. Existing %TBSA burn estimation models (eg, Lund-Browder chart and rule of nines) were derived from a linear formula and a limited number of individuals a century ago and do not reflect the range of body habitus of the modern population.OBJECTIVE To develop a practical %TBSA burn estimation tool that accounts for exact burn injury pattern, sex, and body habitus. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study evaluated the efficacy of a computer vision algorithm application in processing an adult laser body scan data set. High-resolution surface anthropometry laser body scans of 3047 North American and European adults aged 18 to 65 years from the Civilian American and European Surface Anthropometry Resource data set (1998)(1999)(2000)(2001) were included. Of these, 1517 participants (49.8%) were male. Race and ethnicity data were not available for analysis. Analyses were conducted in 2020. MAIN OUTCOMES AND MEASURESThe contributory %TBSA for 18 body regions in each individual. Mobile application for real-time %TBSA burn computation based on sex, habitus, and exact burn injury pattern. RESULTSOf the 3047 individuals aged 18 to 65 years for whom body scans were available, 1517 (49.8%) were male. Wide individual variability was found in the extent to which major body regions contributed to %TBSA, especially in the torso and legs. Anterior torso %TBSA increased with increasing body habitus (mean [SD], 15.1 [0.9] to 19.1 [2.0] for male individuals; 15.1 [0.8] to 18.0 [1.7] for female individuals). This increase was attributable to increase in abdomen %TBSA (mean [SD], 5.3 [0.7] to 8.7 [1.8]) among male individuals and increase in abdomen (mean [SD], 4.6 [0.6] to 6.8 [1.7]) and pelvis (mean [SD], 1.5 [0.2] to 2.9 [0.9]) %TBSAs among female individuals. For most body regions, Lund-Browder chart and rule of nines estimates fell outside the population's measured interquartile ranges. The mobile application tested in this study, Burn Area, facilitated accurate %TBSA burn computation based on exact burn injury pattern for 10 sex and body habitus-specific models.CONCLUSIONS AND RELEVANCE Computer vision algorithm application to a large laser body scan data set may provide a practical tool that facilitates accurate %TBSA burn computation in the modern era.

show abstract

Is Palmar Surface Area a Reliable Tool to Estimate Burn Surface Areas in Obese Patients?

Cited by 14 publications

References 8 publications

A quantitative assessment of variations in the palm surface area as a percentage of total body surface area within the general population

A quantitative assessment of variations in the palm surface area as a percentage of total body surface area within the general population

Does the estimation of burn extent at admission differ from the assessment at discharge?

Practical Computer Vision Application to Compute Total Body Surface Area Burn

Contact Info

Product

Resources

About