Sir,
Proper care of patients with burns requires an accurate assessment of the extent of
the burnt area. The common methods used to measure this are the Lund and Browder chart
(LB),[1] the rule of nines[2] and the patient's palm size method (for smaller burns).[3] Among these, the LB method is the most accurate and popular method of assessing
percentage.[4]
[5]
Burn wound assessment has to be done multiple times and by people with varying degrees
of training and experience. The tool used for such an assessment must be as robust,
precise and reliable as possible and should have the least possible scope for errors.
The conventional (adult) LB chart has anterior and posterior body schematics divided
into regions which represent percentages of total body surface area. These regional
percentages are often in fractions. The actual burnt area is usually irregular and
covers only a part of the region on the chart. This has now to be accurately depicted
onto the paper chart and calculations have to be done. First, the burnt fraction of
the region has to be estimated and then the various fractions of different regions
have to be added up. This estimation and calculations in fractions is difficult. Each
time the observer makes an estimate and a calculation, there is a potential for an
error. There can be significant errors and differences between different assessors,[6] and this can have a profound effect on treatment.
At our hospital, we have modified the adult LB chart in the following way [Figure 1]. Keeping the essential computational integrity of the LB chart intact, each region
is subdivided into smaller areas by lines in such a manner that each resulting quadrilateral
shape represents one quarter of 1% (0.25%). The assessor has to shade in or outline
the burnt area on both anterior and posterior diagrams, then count the number of shaded
or outlined quadrilaterals and divide by four to arrive at the total percentage of
burnt body surface area. This counting of the squares and division by four is easily
done and requires no dealing in fractions.
Figure 1: Adult body surface area grid chartAdult BSA grid chart
Thus, the resolution for this modified chart is 0.25%. Calculation can usually be
done mentally and the result obtained can be easily counterchecked. Results are also
consistent when repeated by different assessors. All that needs to be done is to count
the number of shaded quadrilaterals and divide by four.
This modified LB chart was made using the open source GNU Image Manipulation Program.
Financial support and sponsorship
Nil.
