Diagnosis/Classification of Burns

Classification/Diagnosis of Burns

Burns are typically evaluated on a scale from one to three. First degree burns are characterized by damage only to the top layer of skin or epidermis. Sunburn is the most common example of first degree burns. Long term tissue damage is rare with second degree burns. Second degree burns involve the epidermis and partial involvement of the dermis or deeper layer of the skin (these burns are typically referred to as partial-thickness burns but note that second degree burns can also be full-thickness burns). Second degree burns can be blistered. Third degree burns penetrate the full depth of the epidermis and deeper dermis layer. These are referred to as full-thickness burns.  Some resources also describe forth degree burns to describe burns that have penetrated through the epidermis, dermis, and into the subcutaneous tissue (tendons, musculature, etc). Not all resources will use this fourth degree of classification but will instead use third degree burns to classify burns that penetrate subcutaneous tissue.

In my experience (which admittedly is limited), professionals that care for those who suffer from serious burns do not classify burns by degree but instead by thickness; describing burns as partial or full-thickness. Some continue to further describe partial burns as blanchable or non-blanchable.

Description of burns will also be described within the context of what caused the burn. Electrical burns are different than flame or chemical burns. 

 Diagnosing Total Body Surface Area (TBSA)

Additionally, burns are often characterized by the amount of total body surface area (TBSA %) that they cover. These measurements are rough estimates provided by using the patient's palm equaling 1% of the TBSA. Also, the rule of nine's is employed for estimation. Please see the illustrations below for further embellishment.

Adult Rule of Nines for burn % TBSA

Pediatric Rule of Nines for burn % TBSA with associated growth chart

TBSA along with age are the best indicators of mortality and morbidity when considering large-scale burns.

Additional diagnostic tools such as MRI, x-ray, and others are used to predict possible complications associated with burns. For example, electrical burns may present much differently than fire/flame injuries. Often with electrical burns the greatest level of damage is not to the epidermis and dermis but instead internal tissues and organs. Through the use of MRI physicians can get a better idea of internal tissue necrosis and involved tissues.

For further information about classifying burns and their associated treatment please see the below sources.

American Burn Association. National Burn Repository. 2012th ed. Chicago: n.p., 2012. Web. 4 Apr. 2015. <http://www.ameriburn.org/2012NBRAnnualReport.pdf>.

Burn Triage and Treatment. 2012. U.S. Department of Health and Human Services. Web. 4 Apr. 2015. <http://chemm.nlm.nih.gov/burns.htm#general>.

Blahd, William. Rule of Nines. WebMD, 27 Dec. 2012. Web. 4 Apr. 2015. <http://www.webmd.com/first-aid/rule-of-nines>.

Saad M. AlQahtani, MD, MSc(C); Mohammad M. Alzahrani, MD, MSc(C); Alberto Carli, MD, MSc; Edward J. Harvey, MD, MSc, FRCSC JBJS Reviews, 2014 Oct; 2 (10): e4. http://dx.doi.org/10.2106/JBJS.RVW.N.00010