Burn Evaluation

What is a burn evaluation?

A burn is damage to your skin and/or other tissues that may be caused by:

• Heat, such as fire, steam, and hot surfaces or liquids. These are called thermal burns. They are the most common type of burn.
• Chemicals, such as acids or certain cleaning products.
• Electricity, including lightning.
• Radiation, including:
  • Sunburn.
  • Burns from radiation therapy for cancer.
• Friction. A friction burn happens when skin is scraped on a rough surface. The skin is torn and often burned from the heat caused by friction. Common causes of friction burns include bicycle and motorcycle accidents when skin rubs against the pavement. These friction burns are sometimes called "road rash." Carpet burns and rope burns are also types of friction burns.

A burn evaluation is an exam that health care providers do to find out how serious a burn is. The evaluation is done to estimate:

• How deep into the skin the burn goes. The burn depth may be called the degree of the burn or the thickness of the burn.
• How much of the skin is burned. This is called the extent of the burn.

This information helps providers decide how to treat a burn. You can often treat minor burns at home. But if you've been badly burned, you may need care in a hospital or a special burn center.

Other names: burn assessment

What is a burn evaluation used for?

Burn evaluations are used to find out how serious burn injuries may be. Providers use information from burn evaluations to make a treatment plan and predict how the burn will heal. This includes:

• Deciding if a burn victim needs to receive intravenous (IV) fluids, and if so, how much fluid is needed. Serious burns may cause fluid to leak from tissues. This can lead to dehydration and other complications.
• Deciding whether a burn victim needs care in the hospital or a special burn center.
• Preparing for the risk of complications from burns, such as:
  • Breathing problems
  • Shock, a life-threatening drop in blood pressure
  • Infections and sepsis

What happens during a burn evaluation?

In the case of serious burn injuries, the burn victim is first checked for life-threatening conditions that must be managed right away. These include breathing and blood pressure problems, and other injuries. Clothing will be removed to make sure hot substances and/or chemicals don't continue to cause burns.

When a burn victim is in stable condition, a provider will begin a burn evaluation, which includes two steps.

The first step of a burn evaluation is figuring out the degree of the burn. This means checking to see how far into the skin the burn goes. Burns are grouped into three main types depending on how deep they are:

• First-degree burns are also called superficial burns. These burns are the least serious type. They damage only the outer layer of the skin, called the epidermis. A sunburn is an example of a common first-degree burn. First-degree burns can often be treated at home, at your provider's office, or in an emergency room. They generally heal within a week.

  Signs and symptoms of first-degree burns include:
  • Pain
  • Redness
  • Mild swelling of the skin, but usually no blisters
    
    

• Second-degree burns are also called partial thickness burns. These burns damage 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. Burns that go deep into the dermis are called deep partial thickness burns.

  Signs and symptoms include:
  • Pain
  • Deep redness of the skin
  • Blisters
  • Wet or glossy look from leaking fluid
  • Possible loss of some skin
    
    

• Third-degree burns are also called full-thickness burns. They require emergency medical attention. They damage or completely destroy the entire thickness of the skin.

  Third-degree burns usually require surgery to heal. Signs and symptoms include:
  • Loss of skin layers
  • No pain if the nerves have been destroyed (but you may feel pain from any first or second-degree burns near the third-degree burns)
  • Dry, leathery skin
  • Charred skin or patches that appear white, brown, or black

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.

If a burn victim has burns that are second-degree (partial thickness) or deeper, the provider will continue with the next step of the evaluation.

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) that has second-degree or deeper burns. First-degree burns are not included in this estimate.

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

• The "rule of nines" 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 is the most accurate way to estimate the percentage of the body that's burned, especially for children. Children's body proportions change as they grow, so the chart has different percentages for the head, neck, and body areas based on a child's age.

• The palmar surface or palm method is used in adults and children. It's helpful for estimating the extent of smaller burn areas. With this method, the surface of a person's hand (palm and fingers) equals about 1% of their 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, a provider will also consider the part of the body that's burned, the cause of the burn, and the health of the person with the burn. All of this information helps decide whether a burn is minor, moderate, or severe.

The seriousness of the burn guides treatment decisions. Your provider can explain whether a burn is minor, moderate, or severe and why.

In general:

• Minor burns usually don't require hospitalization and they heal well. They involve only first and/or second-degree burns. But they may still be very painful. They can also make it hard to do normal activities for a few days.
• 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/or 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. Treatment at a burn center 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.

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

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

Is there anything else I should know about a burn evaluation?

You can often treat minor burns at home, but it's important to get medical help if a burn has any of these signs:

• 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

Also, get medical help for all burns that:

• Are caused by electricity or chemicals
• Are on the face, hands, genitals, buttocks, over a joint, or go all the way around a part of the body, such as a leg or the chest
• Happen with inhalation (breathing in) of smoke, hot gasses, or chemicals
• Happen to a child under age 5 or an adult older than age 70