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Improving the Accuracy of TBSA Assessment in Pediatric Burn Patients
Elizabeth M. Waibel, MSN, CPNP; Jennifer Fritzeen, MSN, MSN; Cindy Colson, MSN
Children's National Medical Center, Washington, DC

Purpose: ED providers and surgeons will have accurate and reproducible total body surface area (TBSA) assessment of the pediatric burn patient. Background: Calculating TBSA cannot be accomplished with visualization of the wound. Despite the implementation of tools to aid in the assessment of TBSA, healthcare providers document inaccurate assessment affecting the plan of care.

Methods: Pre and post intervention we compared TBSA assessment between ED LIP and rotating surgical residents to the gold standard of the burn nurse practitioner for agreement. TBSA assessment met agreement standards if the TBSA of the ED provider or surgical resident compared to the TBSA of the nurse practitioner prescribed the same treatment plan. Intervention consisted of the identification of two tools for TBSA assessment, the palm method and the "NSW Trauma" i phone application. Both methods have been shown to be accurate measurement tools and easy to use. The NSW trauma application allows the provider to draw the burn area on a body to create a computer generated TBSA. A burn didactic and simulation management course was developed and implemented to teach use of the tools to rotating surgical residents, ED physicians and ED midlevel providers.

Results: TBSA agreement among ED providers improved from 74% to 92%. TBSA agreement among surgical residents improved from 65% to 94%

Conclusion: Reliable burn TBSA assessment requires consistent use of the same assessment tool and a dedicated education program to teach the use of the assessment tool.


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