Application of hydrosurgery for burn wound debridement: An 8-year cohort analysis
Catherine M. LegemateH. GoeiO.F.E. GostelieTim H.J. NijhuisMargriet E. van BaarCornelis H. van der Vlies
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Debridement (dental)
Skin grafting
Body surface area
Wound care
Burn center
A critical step in managing burn patients is to correctly estimate the percent Total Body Surface Area (%TBSA) of the burn. The fluid requirements for the patient can be estimated using the Parkland formula. The current standard of care is to administer intravenous fluid (IVF) to maintain the urine output (UOP) above 0.5cc/kg/hour. The purpose of this study was to analyze the effect that differences in burn estimates and intravenous fluid administration had on admission urine outputs of burn patients. We hypothesized that burn estimates at outside hospitals significantly differed from our burn center estimates leading to over- or under-resuscitation in burn patients. A retrospective chart review was carried out of all patients suffering thermal injuries who were treated at a Level I trauma center. The %TBSA estimates at referring hospitals were compared to the %TBSA estimated by burn center providers. The Parkland formula was then used to calculate the...
Burn center
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Urine output
Trauma Center
Thermal burn
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Body surface area
Blood Culture
Skin biopsy
Microbiological culture
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Body surface area
Body surface
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Debridement (dental)
Skin grafting
Body surface area
Burn center
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It is current to report the length of stay related to the burn surface area. 1Actual estimate use an average of 0.7 to 1.2 hospitalization day per percent surface burn. However, patients with small burn surface area requiring surgery may need several days between burn and surgery and additional 5–7 days after surgery to allow the skin graft to take. This lead to spuriously high LOS. When calculating the length of stay per surface, we hypothesized that the relation was not constant over the range of burned surface. We extracted from our prospective research database all alive patients admitted primarily to our burn unit from July 1st 2002 to June 30 2005. Patients were discharged to a rehabilitation center or at home. Patients were stratified according to the burn surface area. Over 3 years 344 alive patients were surveyed. Patients with larger burns had a shorter length of stay per percent surface burn. The correlation between LOS and TBSA yield a positive intercept
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Total body surface area (TBSA) burned is a powerful descriptor of burn severity and influences the volume of resuscitation required in burn patients. The incidence and severity of TBSA overestimation by referring institutions (RIs) in children transferred to a burn center (BC) are unclear. The association between TBSA overestimation and overresuscitation is unknown as is that between TBSA overestimation and outcome. The trauma registry at a BC was queried over 7.25 years for children presenting with burns. TBSA estimate at RIs and BC, total fluid volume given before arrival at a BC, demographic variables, and clinical variables were reviewed. Nearly 20 per cent of children arrived from RIs without TBSA estimation. Nearly 50 per cent were overestimated by 5 per cent or greater TBSA and burn sizes were overestimated by up to 44 per cent TBSA. Average TBSA measured at BC was 9.5 ± 8.3 per cent compared with 15.5 ± 11.8 per cent as measured at RIs ( P < 0.0001). Burns between 10 and 19.9 per cent TBSA were overestimated most often and by the greatest amounts. There was a statistically significant relationship between overestimation of TBSA by 5 per cent or greater and overresuscitation by 10 mL/kg or greater ( P = 0.02). No patient demographic or clinical factors were associated with TBSA overestimation. Education efforts aimed at emergency department physicians regarding the importance of always calculating TBSA as well as the mechanics of TBSA estimation and calculating resuscitation volume are needed. Further studies should evaluate the association of TBSA overestimation by RIs with adverse outcomes and complications in the burned child.
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Debridement (dental)
Skin grafting
Body surface area
Wound care
Burn center
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Body surface area
Allowance (engineering)
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Estimation of the surface area involved is vital to evaluation and treatment of burns. Common teaching suggests the palm approximates 1% of the total body surface area (TBSA). However, early century literature suggests the palmar surface of the entire hand approximates 1% of the TBSA. We sought to determine whether the palm or the entire palmar surface of the hand approximates 1% TBSA in children.A prospective, convenience sample.Using height, weight, and standard nomograms, body surface area was determined. A photocopy of the hand was used to determine the surface area of the palm and the entire palmar surface of the hand.In 91 children, the mean percent of the TBSA represented by the entire palmar surface was 0.94% (95% confidence interval (C.I.) 0.93-0.97), and the mean percent of the TBSA represented by the palm was 0.52% (95% C.I. 0.51-0.53).The entire palmar surface of a child's hand more closely approximates 1% TBSA, while the palm approximate 0.5% TBSA.
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