The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind.
BACKGROUND
Accurate estimation of burn size is of critical importance, as it is incorporated in every resuscitation formula. The aim of this study was to investigate total burn surface area (TBSA) accuracy among burn specialists, evaluate the potential impact of incorrect evaluation on variations of resultant fluid resuscitation volumes and to discuss future possibilities to estimate or measure TBSA more precisely.


METHODS
In a poll during two international burn meetings in 2010 and 2011 demonstrating three pictures of patients with different burn wound patterns and sizes we asked participants to estimate the total surface area burned in percentages. We then calculated resultant fluid volume differences based on established resuscitation formulas.


RESULTS
In the polled 80 participants, the estimations for three patients demonstrated the following differences (DIF=MAX-MIN): for patient 1, 2 and 3 they were 22.5 (25-2.5), 16.5 (20-3.5) and 31.5 (40-8.5) %TBSA, respectively. Based on these differences we calculated the volume differences for patients 1,2 and 3, which were 1080ml (Cincinnati Formula), 5280ml (Parkland Formula) and 2016ml (Cincinnati Formula), respectively.


CONCLUSIONS
The analysis showed high deviations of total body surface area among participants, also resulting in large variations of initial fluid resuscitation volumes. One option to address estimation variances is to perform more accurate assessments; also incorporating new technologies aiding to improve the quality of body surface estimations and related decisions.
Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria. Electronic address: daryousch.parvizi@medunigraz.at.
Daryousch
D
Parvizi
Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria. Electronic address: lars.kamolz@medunigraz.at.
Lars-Peter
LP
Kamolz
Research Unit Medical-Informatics, RISC Software GmbH, Johannes Kepler University Linz, Hagenberg, Austria. Electronic address: michael.giretzlehner@risc.uni-linz.ac.at.
Michael
M
Giretzlehner
Trauma Center Linz, AUVA, Linz, Austria. Electronic address: herbert.haller@utanet.at.
Herbert L
HL
Haller
Pediatric Burn Unit, Department of Pediatrics, Medical University of Graz, Graz, Austria. Electronic address: marija.trop@medunigraz.at.
Maria
M
Trop
Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria; Department of Hand, Plastic and Reconstructive Surgery with Burn Unit, Eberhard-Karls-University of Tuebingen, BG Trauma Center, Tuebingen, Germany. Electronic address: selighf@gmail.com.
Harald
H
Selig
Department of Anaesthesiology, Washington University School of Medicine, St. Louis, USA.
Peter
P
Nagele
Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Graz, Austria. Electronic address: david.lumenta@medunigraz.at.
David B
DB
Lumenta
D000328:Adult; D000465:Algorithms; D001830:Body Surface Area; D002056:Burns / Q000175:diagnosis*; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male
Burn resuscitation; Burn size; Fluid management; Fluid resuscitation; TBSA