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EasyTBSA as a method for calculating total body surface area burned: a validation study
  1. Cindy D Colson1,
  2. Emily C Alberto1,
  3. Zachary P Milestone1,
  4. Nikita Batra1,
  5. Tyler Salvador2,
  6. Hadi Fooladi2,
  7. Kevin Cleary2,
  8. Rima Izem3,4,
  9. Randall S Burd1
  1. 1 Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC, USA
  2. 2 Bioengineering Operations, Children's National Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, USA
  3. 3 Department of Pediatrics, Children's National Research Institute, Washington, DC, USA
  4. 4 School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
  1. Correspondence to Dr Randall S Burd, Division of Trauma and Burn Surgery, Children's National Health System, Washington, DC 20010, USA; RBurd{at}


Background Current methods of burn estimation can lead to incorrect estimates of the total body surface area (TBSA) burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centres and fluid overload during resuscitation. To address these challenges, we developed a smartphone application (EasyTBSA) that calculates the TBSA of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the EasyTBSA application and compare its performance to three established methods of burn size estimation (Lund-Browder Chart, Rule of Nines and Rule of Palms).

Methods Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages (infant, child and adult) with different TBSA burns (small <20%, medium 20%–49% and large >49%). We calculated the accuracy of each method as the difference between the user-estimated and actual TBSA. The true value of the complete body surface area of the manikins was obtained by three-dimensional scans. We used multivariable modelling to control for manikin size and method.

Results Among all age groups and burn sizes, the EasyTBSA application had the greatest accuracy for burn size estimation (−0.01%, SD 3.59%) followed by the Rule of Palms (3.92%, SD 10.71%), the Lund-Browder Chart (4.42%, SD 5.52%) and the Rule of Nines (5.05%, SD 6.87%).

Conclusions The EasyTBSA application may improve the estimation of TBSA compared with existing methods.

  • burns
  • triage
  • clinical assessment
  • emergency responders
  • ED

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor Kirsty Challen

  • Contributors All authors have made substantial contributions and met criteria for authorship as defined as (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be resubmitted.CC is the guarantor.

  • Funding RZ's work on this project was supported by grant 5UL1TR001876-03 from the National Center for Research Resources (Guay-Woodford).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.