A 32-year-old man is brought to the emergency department following a flame burn injury sustained in a cooking accident. His wife estimates he was exposed to flames for approximately 10–15 seconds. On examination, he has erythema and blistering over both forearms, anterior chest, and upper abdomen. Which is the most appropriate investigation to accurately determine the percentage of body surface area involved?

Explanation

## Body Surface Area Estimation in Burns: Investigation of Choice ### Why Lund and Browder Chart is the Gold Standard **Key Point:** The Lund and Browder chart is the most accurate method for estimating percentage of body surface area (%BSA) affected in burn injuries, particularly in children and adults with partial-thickness burns. **High-Yield:** The Lund and Browder chart accounts for age-related variations in body proportions (e.g., head is proportionally larger in children, legs smaller), making it superior to the Rule of Nines for precise assessment. ### Comparison of BSA Estimation Methods | Method | Accuracy | Age Adjustment | Clinical Use | Limitations | |--------|----------|-----------------|--------------|-------------| | Lund and Browder | Highest (±5%) | Yes, age-specific | Gold standard, fluid resuscitation | Requires chart, time-consuming | | Rule of Nines | Moderate (±10%) | No, fixed proportions | Quick field estimate, adults | Inaccurate in children <15 years | | Visual inspection | Low (±20%) | No | Initial triage only | Highly subjective, unreliable | | Planimetry | Very high | Yes | Research, medicolegal cases | Impractical in acute setting | ### Clinical Application **Clinical Pearl:** In this case, the patient has burns involving bilateral forearms (~4.5% each = 9%), anterior chest (~9%), and upper abdomen (~4.5%), totalling approximately 22–23% BSA. The Lund and Browder chart would provide the most precise figure, guiding fluid resuscitation (Parkland formula: 4 mL × %BSA × body weight in kg over 24 hours). **Mnemonic:** **LB = Lund & Browder = Lifetime Best** (most accurate for any age, any burn pattern). ### Why Other Methods Fall Short - **Rule of Nines:** Quick but fixed; does not account for age. In a 32-year-old, it is reasonably accurate for rough triage, but lacks the precision of Lund and Browder for treatment decisions. - **Visual inspection alone:** Highly subjective and prone to significant error (±20%), leading to under- or over-resuscitation. - **Planimetry:** Gold standard for medicolegal documentation and research but impractical in the acute emergency setting; requires photography, tracing, and calculation. [cite:Park 26e Ch 14]