Total body surface area burned: A new calculate integrated tool.
by Silvio Fernandes
Coauthors: Authors: Will Ray, Silvio Fernandes-Junior, Sheila Giles, Dana Noffsinger, Brannon Oiler, Brandon Abbott, Dan Digby, Rajan Thakkar, Renata Fabia.
Medical Devices & Digital Health
Errors in estimating the percentage of a total body surface area burn (%TBSA-burned) can have significant negative impacts on care, ranging from increased morbidity and mortality to increased costs. In the United States alone, 500,000 people seek treatment for burn injuries each year. Of those 40,000 required hospitalizations (White et al., 2008). Current methods for estimating the %TBSA-burned are negatively impacted by several sources of error, and inter-rater variability in the estimates is significant (Ray et al., 2022). The TBSA burn impacts almost all aspects of patient care including fluid resuscitation, wound care, etc., and incorrect estimates can be fatal (Baxter and Shires., 1968, Rowan et al., 2015).
We are developing a new software tool for annotating burns in the medical record, which will assist in accurately estimating %TBSA-burned. This tool will support clinicians by giving them the opportunity to concentrate on the assessment of a burn and annotation of its boundaries, rather than on calculation which is where the largest errors occur (Ray et al. 2022). An additional source of error in annotation-based %TBSA approaches is assignment error (Ray et al., 2022) where the assessor encounters difficulty in accurately indicating the boundaries of a burn in an annotation tool. Our tool will minimize this by presenting the annotation task to the user in the context of a familiar, two-dimensional, Lund and Browder chart (Lund and Browder, 1944). The assignment will be constructed on a body-accurate three-dimensional model of the patient onto which data from the 2D diagram is projected. This will enable the clinical assessor to notate burn location and calculate %TBSA-burned in an intuitive, familiar annotation environment more quickly and more accurately. This increased surface-area accuracy is made possible by using a 3D model of the patient to consider the curvatures of the human body. Additionally, this will allow the software to re-project the annotation into other canonical annotation views such as axillary. This will enable detailed annotation of the burn in areas that are challenging to accurately depict in the typical anterior and posterior Lund and Browder views. In preliminary testing of a low-resolution version of this approach, we have demonstrated reductions in average error of over 50%, and a simultaneous reduction in the rate of large errors (Ray et al., 2022). Once complete and validated this software will be made available as a module for use in additional hospital’s Electronic Health Records system.