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Total Body Surface Area (TBSA) estimation is critical for burn management decisions including fluid resuscitation, transfer criteria, and prognosis. This calculator uses the Rule of Nines for rapid assessment. For more accurate assessment, especially in children, use the Lund-Browder chart. Count only 2nd and 3rd degree burns - do NOT include superficial (1st degree) burns.
Calculate Total Body Surface Area affected by burns using Rule of Nines
| Body Area | Adult | Child (5-14y) | Infant (<5y) |
|---|---|---|---|
| Head & Neck | 9% | 18% | 18% |
| Anterior Trunk | 18% | 18% | 18% |
| Posterior Trunk | 18% | 18% | 18% |
| Each Arm | 9% | 9% | 9% |
| Each Leg (Thigh + Lower Leg) | 18% | 14% | 11% |
| Genitals/Perineum | 1% | 1% | 1% |
| Total | 100% | 100% | 100% |
Patient's palm (including fingers) ≈ 1% TBSA. Useful for scattered or irregular burns. Can be combined with Rule of Nines for more accurate assessment.
Total Body Surface Area (TBSA) burned is one of the most important factors in burn management, influencing fluid resuscitation, transfer decisions, and prognosis. Accurate assessment is critical.
The Rule of Nines divides the body into sections representing approximately 9% (or multiples of 9%) of total body surface area. It's quick and easy but less accurate than Lund-Browder charts.
The Lund-Browder chart provides more accurate TBSA estimation, especially in children, by accounting for age-specific body proportions. It's the gold standard but requires a reference chart.
These injuries should be referred to a burn center (based on TBSA and other factors):
TBSA-Related Criteria:
Location-Related Criteria:
Special Circumstances:
1st degree (superficial): Red, painful, no blisters (like sunburn) - NOT counted in TBSA.2nd degree (partial thickness): Blisters, very painful, pink/red base - COUNTED in TBSA.3rd degree (full thickness): White/charred, painless (nerves destroyed), leathery - COUNTED in TBSA.
No. Only count 2nd and 3rd degree burns. Superficial burns (1st degree) don't require fluid resuscitation and heal without scarring. Including them would overestimate fluid needs.
Children have proportionally larger heads and smaller legs compared to adults. An infant's head represents ~18% TBSA (vs 9% in adults) while each leg is ~11% (vs 18% in adults). The Rule of Nines adjusts for these differences, though Lund-Browder charts are more accurate for pediatrics.
Use the palm method: the patient's palm (including fingers) represents approximately 1% TBSA. Count how many "palm-sizes" the burn covers. This is particularly useful for scattered or splash burns. Can be combined with Rule of Nines.
Generally, IV fluid resuscitation (Parkland Formula) is indicated for burns ≥15-20% TBSA in adults or ≥10% in children/elderly. Smaller burns can typically be managed with oral hydration. Always assess individual patient factors.
Yes. Initial assessments can underestimate burn depth, especially in the first 24-48 hours. Areas initially appearing as 1st degree may declare as 2nd degree. Partial thickness burns may convert to full thickness if underperfused. Reassess regularly.
The Lund-Browder chart is considered the gold standard, especially for children, as it accounts for age-specific body proportions. Rule of Nines is faster and easier for initial triage. Digital photography and 3D body mapping are emerging technologies. When possible, have burns assessed by burn specialists.
Yes. Circumferential burns of extremities or chest can cause compartment syndrome or restrict breathing as edema develops. They may require escharotomy (surgical release) even with smaller TBSA. These burns should be transferred to burn centers regardless of total TBSA.