Burn Evaluation

What is a burn evaluation?

A burn evaluation is an exam that health care providers do to find out how serious a burn is. A burn is damage to your skin and/or other tissues that may be caused by:

• Heat from fire, steam, and hot surfaces or liquids. These are called thermal burns and are the most common type of burn. Thermal burns can also happen when your skin is exposed to extreme cold (frostbite).
• Chemicals, such as acids or certain cleaning products.
• Electricity from lightning, automobile batteries, and damaged power cords.
• Radiation from sunburn or radiation therapy for cancer.
• Friction, which happens when skin scrapes against a rough surface such as pavement (“road rash”), carpet, or rope. When this happens, the skin is torn and often burned from the heat caused by friction. Common causes include bicycle and motorcycle accidents.

You can often treat minor burns at home. But you may need care in a hospital or a special burn center if your burn:

• Appears to go deep into the skin
• Is larger than 3 inches across
• Looks leathery and dry
• Has patches of white, brown, or black
• Swells very fast
• Gets more painful over time, has pus, or causes a fever, which may be signs of an infection

Other names: burn assessment

What is a burn evaluation used for?

Burn evaluations are used to find out:

• How deep into the skin the burn goes (this may be called its degree or thickness)
• How much of the skin is burned (this may be called its extent)

Providers use information to make a treatment plan and to predict how long the burn will take to heal. This includes:

• Deciding whether you need care in a hospital or special burn center
• Preparing for the risk of complications from burns
• Determining whether intravenous (IV) fluids are needed, and if so, how much

Serious burns may lead to other health problems, including:

• Difficulty breathing
• Shock, a life-threatening drop in blood pressure
• Infection and sepsis
• Dehydration, which happens when fluid leaks from the burned tissues

Treating burns early can help reduce the risk of other health problems.

What happens during a burn evaluation?

In the case of serious burns, a provider will first check for life-threatening conditions, such as breathing and blood pressure problems, that must be managed right away. Clothing will be removed to make sure any hot substances or chemicals that may still be on them don't continue to cause burns.

If you're in stable condition, a provider will begin a burn evaluation, which includes two steps.

The first step is figuring out how deep into the skin the burn goes (also called its degree).

• First-degree burns (also called superficial burns) are the least serious type. They damage only the outer layer of the skin, called the epidermis, and can often be treated at home, at your provider's office, or in an emergency room. A sunburn is a common example of a first-degree burn. Signs and symptoms of first-degree burns include:
  • Pain
  • Redness
  • Mild swelling of the skin, but usually no blisters
• Second-degree burns (also called partial thickness burns) are more serious and damage both the outer layer of skin and the layer underneath, called the dermis. Burns that involve the top part of the dermis are called superficial partial thickness burns. Those that go deep into the dermis are called deep partial thickness burns. They may require more medical attention. Signs and symptoms of second-degree burns include:
  • Pain
  • Deep redness of the skin
  • Blisters
  • Wet or glossy look from leaking fluid
  • Possible loss of some skin
• Third-degree burns (also called full-thickness burns) can be life-threatening and require emergency medical attention. They damage or completely destroy every layer of the skin. If you have a third-degree burn, you will usually require surgery. Signs and symptoms of third-degree burns include:
  • Loss of skin layers
  • Dry, leathery skin
  • Charred skin or patches that appear white, brown, or black

Third-degree burns don't cause pain if the nerves have been destroyed. However, you may feel pain from any first or second-degree burns on skin near the area of the third-degree burn.

Burns that go into the fat layer under the skin or deeper into the muscle or bone may be called fourth or fifth-degree burns.

The second step of a burn evaluation estimates how much of the body is burned. This estimate is a percentage of the person's total body surface area (TBSA). Your provider will only perform this step if your burn is second-degree or deeper.

There are different ways to estimate the percentage of the body that is burned. These include:

• The “rule of nines” which divides the body into sections that equal about 9% or 18% of the total body surface area. For example, an arm equals 9% of a person's total body surface. This method helps providers quickly estimate how much of the body is burned in adults. For children, the rule of nines has different surface area estimates. That's because children's heads and bodies have different proportions than adults.
• The Lund-Browder chart, which is the most accurate way to estimate the percentage of the body that's burned. The chart has different percentages for the head, neck, and body areas based on your age. This type is especially accurate for children, whose body proportions change as they grow.
• The palmar surface or palm method, which is helpful in estimating the extent of smaller burn areas in adults and children. With this method, the surface of your hand (palm and fingers) equals about 1% of your total body surface area. For example, if you have a burn that appears to be the size of two of your hands, the extent of the burn is about 2% of your total body surface area.

What do the results mean?

To understand the results of a burn evaluation, your provider will consider the part of the body that's burned, the cause of the burn, and your overall health. All this information will help them decide whether a burn is minor, moderate, or severe. It will also help them decide on the best treatment.

Minor burns usually don't require hospitalization and they heal well. They involve only first- and second-degree burns. However, they may still be very painful and may make it hard to do normal activities for a few days.

You can often treat minor burns at home by:

• Using cool water to gently wash your burn
• Covering your burn with a clean bandage or gauze
• Avoiding touching your burn
• Taking over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil)

Moderate burns may require a stay in the hospital, but they usually don't need treatment in a burn center. They involve only first- and second-degree burns that cover a larger area than minor burns. With treatment, they usually heal well.

Severe burns require special care at a burn center and may be recommended for:

• Second-degree burns that cover more than 10% of the body
• Third-degree burns
• Second and third-degree burns of the face, feet, hands, genitals, or over the joints, such as the knees
• Burns that happen with other injuries, such as broken bones
• Burns in people who have other medical conditions that could affect their recovery, such as diabetes or heart disease
• Chemical burns and burns from electricity, including lightning
• Inhalation injuries that may be caused by breathing in smoke, hot gasses from a fire, or other substances that can burn your mouth, airway, or lungs
• Anyone under the age of 5 or over the age of 70

If you have questions about the results of a burn evaluation and burn treatment, talk with your provider.

Learn more about laboratory tests, reference ranges, and understanding results.