🔥 Burn Surface Area (Rule of Nines)
UseGuide burn fluid resuscitation and burn-center referral.
StrataAdults with roughly ≥15–20% TBSA usually need formal fluid resuscitation (often Parkland) and burn-centre ref…
LimitsDo not count first-degree (erythema-only) burns toward %TBSA. · Children need Lund-Browder charts — adult nines overestimate paediatr… · Reassess after debridement; initial ED estimates often change.
SourceWallace AB. The exposure treatment of burns (rule of nines). Lancet 1951
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
≥ 15–20% TBSA needs formal fluid resuscitation (Parkland).
When to use
Guide burn fluid resuscitation and burn-center referral.
How it works
Head/neck 9, each arm 9, anterior/posterior trunk 18 each, each leg 18, perineum 1 (100% total). Count second-degree and deeper only.
Key points
- ≥ 15–20% TBSA needs formal fluid resuscitation (Parkland).
- Palm (incl. fingers) ≈ 1% TBSA for small burns.
- Use the Lund-Browder chart in children.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Head & neck (max 9%) | Front/back (4.5) |
|---|---|
| Right arm (max 9%) | Front/back (4.5) |
| Left arm (max 9%) | Front/back (4.5) |
| Anterior trunk (max 18%) | Chest or abdomen (9) |
| Posterior trunk (max 18%) | Half (9) |
| Right leg (max 18%) | Front/back (9) |
| Left leg (max 18%) | Front/back (9) |
| Perineum (max 1%) | None (0) |
→Total burn surface area49.5 % TBSA
- Area：49.5% (Large area (aggressive fluid resuscitation)). Count second-degree and deeper only
- Resuscitation：≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 198 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h
- Small/scattered：Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA
| Head & neck (max 9%) | None (0) |
|---|---|
| Right arm (max 9%) | None (0) |
| Left arm (max 9%) | None (0) |
| Anterior trunk (max 18%) | None (0) |
| Posterior trunk (max 18%) | None (0) |
| Right leg (max 18%) | None (0) |
| Left leg (max 18%) | None (0) |
| Perineum (max 1%) | None (0) |
→Total burn surface area0 % TBSA
- Area：0% (Smaller area). Count second-degree and deeper only
- Resuscitation：≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 0 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h
- Small/scattered：Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA
Verification & sources · governance
FAQ
Frequently asked questions
- Does Burn Surface Area (Rule of Nines) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Burn Surface Area (Rule of Nines) calculated in practice? Can you show a worked example?
- Inputs: Head & neck (max 9%) Front/back (4.5), Right arm (max 9%) Front/back (4.5), Left arm (max 9%) Front/back (4.5), Anterior trunk (max 18%) Chest or abdomen (9), Posterior trunk (max 18%) Half (9), Right leg (max 18%) Front/back (9), Left leg (max 18%) Front/back (9), Perineum (max 1%) None (0) → Result: Total burn surface area 49.5 % TBSA（Area: 49.5% (Large area (aggressive fluid resuscitation)). Count second-degree and deeper only, Resuscitation: ≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 198 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h, Small/scattered: Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA） Inputs: Head & neck (max 9%) None (0), Right arm (max 9%) None (0), Left arm (max 9%) None (0), Anterior trunk (max 18%) None (0), Posterior trunk (max 18%) None (0), Right leg (max 18%) None (0), Left leg (max 18%) None (0), Perineum (max 1%) None (0) → Result: Total burn surface area 0 % TBSA（Area: 0% (Smaller area). Count second-degree and deeper only, Resuscitation: ≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 0 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h, Small/scattered: Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA）