Total body surface area ( TBSA ) is an assessment of injury to or disease of the skin , such as burns or psoriasis .
7-521: In adults, the Wallace rule of nines can be used to determine the total percentage of area burned for each major section of the body. In burn cases that involve partial body areas, or when dermatologists are evaluating the Psoriasis Area and Severity Index (PASI) score, the patient's palm can serve a reference point roughly equivalent to 1% of the body surface area. For children and infants,
14-414: A patient's left leg were burned, it would be assigned a BSA value of 9% (half the total surface area of the leg). Thus, if a patient's entire back (18%), but only half of their left leg (9%) was burned, the amount of BSA affected would be 27%. Some studies have raised concerns about the rule of nines' accuracy with obese patients, noting that "the proportional contribution of various major body segments to
21-437: Is a tool used in pre-hospital and emergency medicine to estimate the total body surface area (BSA) affected by a burn . In addition to determining burn severity, the measurement of burn surface area is important for estimating patients' fluid requirements and determining hospital admission criteria. The rule of nines was devised by Pulaski and Tennison in 1947, and published by Alexander Burns Wallace in 1951. To estimate
28-477: The Lund and Browder chart is used to assess the burned body surface area. Different percentages are used because the ratio of the combined surface area of the head and neck to the surface area of the limbs is typically larger in children than that of an adult. Typical values for common groups of humans follow. (Due to rounding, values may not add to 100%.) Wallace rule of nines The Wallace rule of nines
35-435: The body surface area of a burn, the rule of nines assigns BSA values to each major body part: This allows the emergency medical provider to obtain a quick estimate of how much body surface area is burned. For example, if a patient's entire back (18%) and entire left leg (18%) are burned, about 36% of the patient's BSA is affected. The BSAs assigned to each body part refer to the entire body part. So, for example, if half of
42-485: The total body surface area changes with obesity". One study found the rule's accuracy to be "reasonable" for patients weighing up to 80 kg, but proposed a new "rule of fives" for patients over that weight: Other studies have found that the rule of nines tends to over-estimate total burn area, and that ratings can be subjective, but that it can be performed quickly and easily, and provide reasonable estimates for initial management of burn patients. The rule of nines
49-403: Was designed for adult patients. It is less accurate in young children due to their proportionally bigger heads and smaller mass in the legs and thighs, although one study did find it was accurate for patients as small as 10 kg. To account for children's proportional differences, a "rule of nines for children" was proposed. The head is assigned 18% BSA while each leg is 13.5%. The remainder of
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