In burn medicine, the percentage of the burned body surface area (TBSA-B) to the total body surface area (TBSA) is a crucial parameter to ensure adequate treatment and therapy. Inaccurate estimations of the burn extent can lead to wrong medical decisions resulting in considerable consequences for patients. These include, for instance, over-resuscitation, complications due to fluid aggregation from burn edema, or non-optimal distribution of patients. Due to the frequent inaccurate TBSA-B estimation in practice, objective methods allowing for precise assessments are required.
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Due to the frequently occurring inaccurate estimation of the burn size in practice and the associated far-reaching consequences for patients and medical resources, objective methods allowing for a more accurate burn size assessment are required. Over time, various methods have been established, whose development has been influenced by contemporary technical standards. The following is an extract of burn size estimation history and shows methods proven in practice or with high practical potential. Figure 1 shows this extract of TBSA-B determination methods as a timeline.
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[9][10], it has remained in use in its original form until the present. The “Lund Browder Chart” illustrates the human body’s front and back in a graphic model and assigns different body proportions to different age groups. It shows the boundaries of specific body regions for which different percentages of TBSA are defined. For the calculation procedure, an adapted planimetry is used. Even though the “Lund Browder Chart” does not differentiate depending on sex, weight, height, or body shape, many authors consider it “the most accurate” method [11] (p. 58).
Continuing with the history of burn size estimation, another method still used in practice is the so-called “Rule of Nines”. In his publication in 1951, Wallace
[124] assumed for different body parts the following proportions of the TBSA: arms 9% of the TBSA each, legs 18% each, chest and back 18% each, head and face 9%, neck 1%, and genital area 1%. Like the “Lund Browder Chart”, the “Rule of Nines” ignores differences in sex, weight, height, and body shapes. When using this rule, the burn extent is overestimated in many cases [13][14]. For example, Giretzlehner et al. [15] reported a mean overestimation rate of 138% using the “Rule of Nines” and the “Lund Browder Chart”.
[1611] relies on the original “Lund Browder Chart”. It can be applied either alone or in combination with other methods such as the “Lund Browder Chart” to estimate the TBSA-B of a specific body region. In its simplest form, the “Rule of Palms” states that the patient’s hand’s surface accounts for approximately 1% of the TBSA. Due to different understandings on whether the palm should be calculated including or excluding fingers, this rule is used inconsistently in practice [17]. It is mainly applied to measure the size of reasonably small burn injuries [18].
[2013] were among the first to employ electronic systems. Two-dimensional (2D) computer models rely on simple human body drawings on a computer screen. These models do not consider the human body’s three-dimensionality, and in many applications, it is not possible to capture the lateral and other parts of the body. Moreover, 2D models usually do not depict individual differences in sex, weight, height, and body shape. Nevertheless, they are easy to handle but can only provide a rather rough overview of the burn type and the affected areas, particularly on the lateral parts of the body. In many cases, they miss the actual extent of the burned area. The planimetry type can be distinguished between simple planimetry and adapted planimetry. While the former is related to a simple pixel count in a 2D image and is used in some electronic devices, the latter is a pixel count in a 2D image that is additionally corrected by a particular percentage recommended for a specific body region.
Any documentation aims to make the documented facts available. In most cases, such documentations focus on gathering data itself rather than making existing data available.
Although paper-based documentation has significant shortcomings compared to electronic wound documentation [25], many institutions still use paper forms (or free-text electronic forms). The literature shows that most clinical systems do not meet the known requirements for successful burn documentation. Many existing documentation systems use predefined terms without indicating their sources or have deficiencies in capturing a patient’s complete medical history due to the lack of standards. Besides, most of them do not include the ability to perform statistical analysis of the collected data simultaneously, and only a few systems can collect data via mobile devices [26].
Electronic documentation systems proved qualitative and quantitative advantages in several studies. They enhance documentation quality, reduce documentation errors, and result in positive attitudes among medical staff. Advantages like better availability and evaluability of the collected data, the more direct exchange of information (for consultation of experts), easier access to resources, and creation of new medical knowledge were described by Törnvall et al. [27] and Kinnunen et al. [28].