## Burn Severity Classification and Referral Criteria **Key Point:** Burns of even modest TBSA require specialist burn center care if they involve specific anatomical sites or have complications. The American Burn Association (ABA) has clear criteria for transfer to a burn center, and <10% TBSA does NOT automatically mean outpatient management is safe. **High-Yield:** Burns requiring transfer to a burn center include: - Partial-thickness burns >10% TBSA - Full-thickness burns of any size - Burns involving face, hands, feet, genitalia, perineum, or major joints - Circumferential burns of extremities or chest - Inhalation injury, electrical burns, chemical burns - Burn injury in patients with significant comorbidities or extremes of age A 5% TBSA partial-thickness burn to the hand, for example, requires specialist care despite being <10% TBSA. ## Why the Other Options Are Correct | Feature | Description | |---------|-------------| | **Full-Thickness (3rd degree)** | White/charred, painless (nerve destruction), non-blanching, requires grafting. | | **Deep Partial-Thickness (Deep 2nd degree)** | Painful, blistering, slow healing with hypertrophic scarring; often requires grafting for optimal outcome. | | **Rule of Nines (Adult)** | Head 9%, each arm 9%, chest 18%, abdomen 18%, each leg 18%, perineum 1%. | **Clinical Pearl:** The depth and location of the burn matter as much as the percentage. A 5% TBSA burn to the hand or face is more serious than a 10% TBSA burn to the back, and both warrant specialist evaluation. [cite:ATLS 10e Ch 7; American Burn Association Burn Center Referral Criteria]
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