The accuracy of burn TBSA estimation in referrals to a regional burns unit

Dr Alexandra Carswell1, Dr  Rahul Jayakar1, Dr Joseph  Chen1, Mr  Christopher Adams1

1Dept of Plastic and Reconstructive Surgery, Hutt Hospital, Hutt Valley DHB, Lower Hutt, NZ , Lower Hutt, New Zealand


Background: Estimation of burn size is an essential first step in the management of the burned patient. Accurately determining the total body surface area (TBSA) determines management, as it guides volume of fluid resuscitation and referral to specialist burns units.

Aim: This audit was performed to document the accuracy of burn TBSA estimation by referral centres when referring patients to our regional burn unit; and identify any factors that may impact on this.

Methods: Retrospective review of consecutive patients referred to a regional burns centre for management of moderate sized burns from 2013 – 2017. Data was retrieved from a prospectively maintained burns database. Inclusion criteria: All burns managed at HVDHB that were estimated or referred as >10%TBSA. Primary Variables were: demographics, method of injury, estimated TBSA, final calculated TBSA, time to arrival, fluid resuscitation accuracy and 30 day complications.

Results: 80 patients were included in our study. There were 14 children and 66 adults.  Mean TBSA burn referred was 19% TBSA (median =15, range 7-65 %). There was a trend to overestimate burn size. This was significant when burn was >20% TBSA for adults (p = 0.0003). This resulted in over prescription of resuscitation fluids by some centres.

Conclusions: There are inaccuracies in referral TBSA estimations, with a trend to overestimate. This audit did not reveal factors impacting on this, but suggests the need for further, larger reviews, to assess the effect this overestimation has on patient outcomes.


Dr Alex Carswell graduated from the University of Otago medical school in 2017. She is currently a house surgeon at the Plastics and Reconstructive Surgery Department at Hutt Hospital. She has an interest in the care of the burned patient, including the effect that initial estimation of burn TBSA ultimately has on patient care.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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