Temporal trends in burns size estimation: a longitudinal study

Dr  Thanya  Sritharan1,2, Dr Varun Harish1,2

1Royal North Shore Hospital, St Leonards, Australia, 2University of Sydney, Australia


Background: Burn size estimation by referring hospitals is known to be inaccurate when compared to burns units, resulting in suboptimal management. This study compared the accuracy of burn size estimation between two time periods to gauge the impact of education and app-based technologies.

Methods: A review of all adults transferred to Burns units in Sydney, Australia between August 2014 and January 2021 was performed. The TBSA estimated by the referring institution was compared with the TBSA measured at the Burns Unit. This was compared to historical data from the same population between January 2009 and August 2013.

Results: There were 767 patients transferred to a Burns Unit between 2014 and 2021. In 38% of patients, the TBSA estimations were equivalent; this represents a significant improvement compared to the preceding period (30%, p < 0.005). In 48% of patients, the TBSA was overestimated by the referring hospital; significantly reduced compared to previous (53%, p < 0.001). Overestimation occurred 3.3 times more often than underestimation. In the previous period, significant overestimation occurred in burns transferred within 12h and after 48h from injury (p < 0.005); this was not evident in the contemporary period where increasing time from burn to admission was associated with a more accurate estimation (p < 0.005) regardless of burn severity.

Conclusion: There have been marginal improvements in burns size estimation over the last decade. This may be attributable to education and technology. While accurate burn size estimation has increased, there remains a large proportion of inaccurately estimated burns.


Thanya Sritharan is a junior doctor at Royal North Shore Hospital with a growing interest in burns care and research. She completed her undergraduate degree at Western Sydney University in 2019 and has since commenced a Masters of Surgery with the University of Sydney.

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