Pediatric Trauma Society

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Validation of Palmar TBSA Estimates using CT Modelling
*Andrew Nordin, Swathi Vudatala, *Rajan K Thakkar, Wolfgang Rumpf, Will Ray, *Renata Fabia
Nationwide Children's Hospital, Columbus, OH

Background:
Accurate, rapid determination of the total body surface area (TBSA) burned is critical to guide management for pediatric burn patients. Providers may estimate TBSA burned using Lund-Browder (LB) charts or palmar surface area, which is considered to represent 1% TBSA. Previously published palmar areas are variable, and may or may not include finger surface area. We sought to confirm that palmar surface area including fingers (PSAF) accurately represents 1% TBSA in pediatric burn patients.
Methods:
We obtained full-body computed tomography scans for 11 patients ranging 9 months to 15 years old who were BMI outliers. From these scans, we constructed 3-D surface models and calculated TBSA and PSAF. Average PSAF for the overall sample and for each LB group was compared against the expected 1% area; PSAF was also compared between groups. Statistics were performed using Student’s t-test.
Findings:
The average age was 6.5 years, and average overall PSAF was 0.96% (p = 0.14). When LB subgroups were analyzed individually, infants (0-1 years) had a significantly higher average PSAF (1.10%) than children 1-4 (0.91%; p = 0.0002) or 10-14 years old (0.91%; p = 0.009). Only the 1-4 year group had an average PSAF significantly different from the expected 1% value (p = 0.0001).
Conclusions:
PSAF reasonably approximates 1% TBSA even for extreme high and low BMI patients, suggesting that finger surface area should be included in this method of estimating burn size. Differences between LB age groups are likely a consequence of the small sample size and are of uncertain clinical significance. Further prospective studies should be performed.


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