Total body surface area (TBSA)
- Using the Rule of Nines, complete the burn distribution assessment for total body surface area (TBSA).
- Do not include epidermal burn, i.e. ignore simple erythema, when attending TBSA.
- Expose the whole body, ensuring you inspect and calculate anterior and posterior surfaces.
- A calculator for TBSA is available in the NSW trauma app.
Rule of Nines
- The Rule of Nines allows the extent of the burn to be estimated with reproducible accuracy.
- The TBSA is divided into areas of 9% or multiples of 9%.
- The perineum is estimated at 1%.
- Small burns may be estimated by using the palmar surface, fingers and palm of the patient's hand, which is approximately 1% of the body surface area.
- When calculating the TBSA, ignore simple erythema.
Burn depth
- Use the following table to assess the depth of the burn.
- Burn may deepen over time.
- Take photos with consent before and after cleaning.
Drag the table right to view more columns or turn your phone to landscape
Depth | Colour | Blisters | Capillary refill | Sensation |
---|---|---|---|---|
Epidermal | Red | No | Brisk 1–2 seconds | Present |
Superficial dermal | Red to pale pink | Small | Brisk 1–2 seconds | Painful |
Mid-dermal | Dark pink | Present | Sluggish over 2 seconds | +/- |
Deep dermal | Blotchy red to white | +/- | Sluggish over 2 seconds to absent | Absent |
Full thickness | White, brown, black charred or deep red | No | Absent | Absent |
Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/ecat/adult/assessment/burn