Plastic Surgery

Burn severity assessment begins with accurate total body surface area (TBSA) calculation using the Rule of Nines for adults and the Lund-Browder chart for children, which accounts for developmental changes in body proportions. TBSA is the primary determinant of fluid resuscitation volume, transfer to a burn center, and mortality risk.

Fluid resuscitation in burn shock follows the Parkland formula (4 mL/kg/%TBSA lactated Ringer's in the first 24 hours), with half of the volume administered in the first 8 hours post-injury and the remainder over the subsequent 16 hours. The modified Brooke formula (2 mL/kg/%TBSA) provides an alternative approach aimed at reducing fluid overload and abdominal compartment syndrome.

The revised Baux score (age + %TBSA + 17 [if inhalation injury]) predicts burn mortality and guides triage decisions including palliative care consideration in patients with predicted mortality exceeding 90%. The ABSI (Abbreviated Burn Severity Index) provides an alternative five-variable mortality prediction model.