Classification of burns
- Phillip L Rice, Jr, MD
Phillip L Rice, Jr, MD
- Instructor in Medicine
- Harvard Medical School
- Dennis P Orgill, MD, PhD
Dennis P Orgill, MD, PhD
- Associate Professor of Surgery
- Harvard Medical School
A burn is defined as a traumatic injury to the skin or other organic tissue primarily caused by thermal or other acute exposures. Burns occur when some or all of the cells in the skin or other tissues are destroyed by heat, cold, electricity, radiation, or caustic chemicals. Burns are acute wounds caused by an isolated, non-recurring insult and progress rapidly through an orderly series of healing steps .
The most common types of burns and their classification will be reviewed here. The clinical assessment, potential acute complications, and management of moderate and severe burns in adults and children, minor burns, and other related injuries are discussed elsewhere. (See "Emergency care of moderate and severe thermal burns in adults" and "Emergency care of moderate and severe thermal burns in children" and "Treatment of minor thermal burns" and "Smoke inhalation" and "Environmental and weapon-related electrical injuries".)
TYPES OF BURNS
The most common type of burn in children is from a scald injury; in adults, the most common burn occurs from a flame. The following is a list of the types of burns that may be incurred by adults and children.
Thermal — The depth of the burn injury is related to contact temperature, duration of contact of the external heat source, and the thickness of the skin. Because the thermal conductivity of skin is low, most thermal burns involve the epidermis and part of the dermis . The most common thermal burns are associated with flames, hot liquids, hot solid objects, and steam. The depth of the burn largely determines the healing potential and the need for surgical grafting. (See "Emergency care of moderate and severe thermal burns in adults".)
Cold exposure (frostbite) — Damage occurs to the skin and underlying tissues when ice crystals puncture the cells or when they create a hypertonic tissue environment. Blood flow can be interrupted, causing hemoconcentration and intravascular thrombosis with tissue hypoxia. (See "Frostbite".)
- American Burn Association White Paper. Surgical management of the burn wound and use of skin substitutes. Copyright 2009. www.ameriburn.or (Accessed on January 04, 2010).
- Orgill DP, Solari MG, Barlow MS, O'Connor NE. A finite-element model predicts thermal damage in cutaneous contact burns. J Burn Care Rehabil 1998; 19:203.
- Wolbarst AB, Wiley AL Jr, Nemhauser JB, et al. Medical response to a major radiologic emergency: a primer for medical and public health practitioners. Radiology 2010; 254:660.
- Mertens DM, Jenkins ME, Warden GD. Outpatient burn management. Nurs Clin North Am 1997; 32:343.
- Baxter CR. Management of burn wounds. Dermatol Clin 1993; 11:709.
- Pham, TN, Girban, NS, Heimbach, DM. Evaluation of the burn wound: Management decisions. In: Total Burn Care, 3rd edition, Herndon, D (Eds), Saunders Elsevier, Philadelphia 2007. p.119.
- Orgill DP. Excision and skin grafting of thermal burns. N Engl J Med 2009; 360:893.
- Collis N, Smith G, Fenton OM. Accuracy of burn size estimation and subsequent fluid resuscitation prior to arrival at the Yorkshire Regional Burns Unit. A three year retrospective study. Burns 1999; 25:345.
- Hagstrom M, Wirth GA, Evans GR, Ikeda CJ. A review of emergency department fluid resuscitation of burn patients transferred to a regional, verified burn center. Ann Plast Surg 2003; 51:173.
- Freiburg C, Igneri P, Sartorelli K, Rogers F. Effects of differences in percent total body surface area estimation on fluid resuscitation of transferred burn patients. J Burn Care Res 2007; 28:42.
- Woodson, LC, Sherwood, ER, Aarsland, A, et, al. Anesthesia for burned patients. In: Total Burn Care, 3rd edition, Herndon, DN (Eds), Saunders Elsevier, Philadelphia 2007. p.196.
- Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet 1944; 79:352.
- Monafo WW. Initial management of burns. N Engl J Med 1996; 335:1581.
- Wachtel TL, Berry CC, Wachtel EE, Frank HA. The inter-rater reliability of estimating the size of burns from various burn area chart drawings. Burns 2000; 26:156.
- Perry RJ, Moore CA, Morgan BD, Plummer DL. Determining the approximate area of a burn: an inconsistency investigated and re-evaluated. BMJ 1996; 312:1338.
- Sheridan RL, Petras L, Basha G, et al. Planimetry study of the percent of body surface represented by the hand and palm: sizing irregular burns is more accurately done with the palm. J Burn Care Rehabil 1995; 16:605.
- Nagel TR, Schunk JE. Using the hand to estimate the surface area of a burn in children. Pediatr Emerg Care 1997; 13:254.
- Hidvegi N, Nduka C, Myers S, Dziewulski P. Estimation of breast burn size. Plast Reconstr Surg 2004; 113:1591.
- TYPES OF BURNS
- Cold exposure (frostbite)
- Chemical burns
- Electrical current
- Radiation burns
- Associated injuries
- Burn depth
- - Superficial
- - Partial-thickness
- - Full-thickness
- - Fourth degree burns
- PERCENT BODY SURFACE AREA ESTIMATES
- Rule of Nines
- Palm method
- Anterior chest wall burns in women