## Distinguishing Features of BSA Estimation Methods ### Rule of Nines vs Lund and Browder Chart **Key Point:** The fundamental difference lies in age-related anatomical adjustments. The Rule of Nines applies fixed percentages (head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%), which remain constant across all ages. In contrast, the Lund and Browder chart recognizes that children have proportionally larger heads and smaller legs compared to adults. ### Age-Related Variations in BSA Distribution | Body Region | Newborn | 5-year-old | Adult | |---|---|---|---| | Head | 21% | 17% | 9% | | Each Leg | 13.5% | 16% | 18% | | Anterior Trunk | 21% | 17% | 18% | **High-Yield:** The Lund and Browder chart provides separate columns for different age groups (0–1 year, 1–4 years, 5–9 years, 10–15 years, adult), making it the gold standard for pediatric burn assessment. The Rule of Nines, while simpler and faster, systematically overestimates head burns and underestimates leg burns in children. **Clinical Pearl:** In emergency settings, the Rule of Nines is used for rapid triage and fluid resuscitation initiation, but the Lund and Browder chart should be applied once the patient reaches the burn center for precise documentation and ongoing management. **Mnemonic:** **"Rule of Nines = Same for all ages; Lund & Browder = Age-adjusted"** [cite:Park 26e Ch 13]
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