title: Burn size estimation in children: still a problem.
abstract: BACKGROUND
  Accurate determination of burn size and depth forms an integral part of the initial assessment of any burn injury. Errors might lead to inaccurate fluid resuscitation and inappropriate transfer of patients to specialized burns units (BUs). Although recent data suggest some improvement in the estimation of burn injury in adults, this has not been shown in children.
  
  
  METHODS
  A retrospective review of children with burn injuries referred to the BU of our institution was performed. Data were collected from all patients presenting to the BU during the calendar year 2009. The total body surface area burned (TBSA-B) estimated by the referring centre was compared with the actual TBSA determined measured on arrival at the BU.
  
  
  RESULTS
  Of the 71 paediatric patients referred during the study period, 10 did not have any TBSA-B estimation documented by the referring hospital. Inaccurate estimation of burn area was noted in 48 out of 61 patients (79%). Burn size was more likely to be overestimated than underestimated by a ratio of 2.2 to 1, especially in burns >10% TBSA-B (P= 0.002).
  
  
  CONCLUSIONS
  Inaccurate estimation of burn size remains a problem in children. The persistent miscalculation of burn size might be a result of the various methods employed in assessing burn area, the inclusion of simple erythema and inadequate training or exposure of first responders. Accurate assessment of TBSA-B and burn depth in children remains elusive and would appear to require additional training and education.
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital Burns Research Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Queenie E
authors.initials: QE
authors.lastname: Chan
authors.forename: Federica
authors.initials: F
authors.lastname: Barzi
authors.forename: Lukas
authors.initials: L
authors.lastname: Cheney
authors.forename: John G
authors.initials: JG
authors.lastname: Harvey
authors.forename: Andrew J A
authors.initials: AJ
authors.lastname: Holland
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000150:complications / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies