Classification of burn injury
- 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
Burns are commonly thought of as injury to the skin caused by excessive heat. More broadly, burns result from traumatic injuries to the skin or other tissues 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, electrical discharge, friction, chemicals, or radiation. Burns are acute wounds caused by an isolated, non-recurring insult, and healing ideally progresses rapidly through an orderly series of steps .
The mechanisms that result in burns and their classification will be reviewed here. The clinical assessment and management of burns in adults and children are discussed elsewhere. (See "Treatment of minor thermal burns" and "Overview of the management of the severely burned patient".)
Heat — The depth of the thermal 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.
Electrical discharge — Electrical energy is transformed into heat as the current passes through poorly conducting body tissues. Electroporation (injury to cell membranes) disrupts membrane potential and function. The magnitude of the injury depends on the pathway of the current, the resistance to the current flow through the tissues, and the strength and duration of the current flow. (See "Environmental and weapon-related electrical injuries".)
Friction — Injury from friction can occur due to a combination of mechanical disruption of tissues as well as heat generated by friction.
- 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.
- 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, et al. 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.
- Woodson LC, Sherwood ER, Aarsland A, et al. Anesthesia for burned patients. In: Total Burn Care, 3rd edition, Herndon DN (Ed), 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.
- 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.
- Hidvegi N, Nduka C, Myers S, Dziewulski P. Estimation of breast burn size. Plast Reconstr Surg 2004; 113:1591.
- BURN MECHANISMS
- Electrical discharge
- CLASSIFICATION BY DEPTH
- Extension to deep tissues
- EXTENT OF BURN INJURY
- Methods of estimation
- Accuracy of TBSA estimates
- ANATOMIC LOCATION OF BURN INJURY
- OVERALL SEVERITY OF BURN INJURY
- Minor or mild burn injury
- Moderate burn injury
- Severe burn injury