title: Using the hand to estimate the surface area of a burn in children.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A prospective, convenience sample.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The entire palmar surface of a child's hand more closely approximates 1% TBSA, while the palm approximate 0.5% TBSA.
authors.affiliation: Emergency Department, Southwestern Texas Methodist Hospital, San Antonio, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Nagel
authors.forename: J E
authors.initials: JE
authors.lastname: Schunk
mesh_terms: D000293:Adolescent; D001830:Body Surface Area; D002056:Burns / Q000145:classification*; D002648:Child; D002675:Child, Preschool; D006225:Hand; D006801:Humans; D007223:Infant; D012680:Sensitivity and Specificity