Medical providers need to know the relative size of a burn by using the rule of nine to decide on treatments. The rule of nine is generally not necessary in first-degree combustion feeding. However, the nine-adult rule is not recommended for the treatment of minors. For these pediatric patients, the rule of nine is adapted to the proportional differences of the head, trunk and legs. Due to the inherent nature of error in human assessment of burns also in rule-making, computer applications are produced for smartphones to minimize over- and underestimation of TBSA percentages. The applications use standardized sizes of male and female models of small, medium and obese sizes. Applications are also geared towards infant measurements. These computer applications see variability in the reporting of TBSA percentages, ranging from an overestimation of up to 60% of the combustion surface area to an underestimation of 70%. Diagram of the 9s rule for adults. CC BY-SA 3.0, created by Commons Wiki user Jmarchn, creativecommons.org/licenses/by-sa/3.0/ Emergency doctors are among the medical staff who most often apply the rule of nine. They quickly appreciate the fire zone to decide on treatments on the way to the hospital. Other studies have shown that the rule of nine tends to overestimate the total burn area,[5] and that assessments can be subjective,[6] but can be done quickly and easily, providing reasonable estimates for the initial treatment of burn patients. [5] Determining the total body surface area of a burn using the Rule of Nine can help doctors plan a skin graft treatment.
Many other rules for estimating the size of a burn can apply to overweight patients. Depending on their body shape, different body parts have different percentages of the total body surface area. Diagram of the 9s modification rule for paediatric patients. Contributed by Rian Kabir, MD Some studies have raised concerns about the accuracy of the rule of nine in obese patients, noting that “the proportional contribution of various important body segments to total body surface area changes with obesity.” [1] One study found that the accuracy of the rule is “reasonable” for patients weighing up to 80 kg, but suggested a new “rule of five” for patients above this weight:[1] It is important to note the differences between the nine adults and pediatrics. There are two main differences for children aged zero to nine: To estimate the body surface area of a burn, the rule of nine assigns BSA values to each major part of the body:[3] The rule of nine was developed for adult patients. It is less accurate in young children due to their proportionally larger head and smaller mass in the legs and thighs, although one study found it was as small as 10kg accurate for patients. [1] In order to account for proportional differences between children, a “rule of nine for children” has been proposed. [7] The head is assigned 18% BSA, while each leg is 13.5%. The rest of the body parts maintain the same BSA percentages used in the adult rule of nine. [8] The Rule of Nine is a tool that allows you to estimate the percentage of a burn all over your skin. It divides your body into sections at a multiple of 9% each. Human error.
Burns can spread throughout your body, so they are unevenly distributed in the nine-section rule. The size, shape, and depth of a burn can make it difficult to guess the percentage of the total body surface area. When calculating TBSA, the burn crew or emergency services use the Rule of Nines body map as a guide. This graph shows the percentage of each part of the body, front and back. Each body part is divided into 9% increments, hence the rule of nine. For example, each adult arm accounts for 4.5% for the front and 4.5% for the back, which is 9% for each arm out of a total of 100% of the whole body. Each adult leg counts for 9% for the front and 9% for the back, a total of 18% for the whole leg and so on. If burns spread or there are burnt spots here and there, it is common to use the size of the patient`s palm to calculate areas, counting the palm of the hand at 1%. Wallace`s Rule of Nine is a tool used in preclinical and emergency medicine to estimate the total body surface area (BSA) affected by a burn.