Burn TBSA & Parkland Calculator
Both the adult and paediatric charts total 100, because the head and leg differences cancel — which is exactly why using the wrong one hides.
A study aid, not a resuscitation tool. Parkland is a starting estimate titrated to urine output and clinical response, never a prescription — modern practice frequently gives less than the classic formula. The Rule of Nines is an approximation; Lund-Browder is the age-graded standard. Local protocol and the people at the bedside govern, not a calculator.
How much of each region is burned
Partial and full thickness only. Superficial burns are excluded from the total entirely.
The two charts side by side
What the delay costs
Both charts total 100, which is why the error hides
An infant's head is 18 per cent of body surface against an adult's 9, and each leg is 13.5 against 18. So the head gains nine points, the legs lose nine, and they cancel exactly — both charts sum to 100. Apply the adult chart to a small child and the total still looks entirely plausible; nothing about the number tells you the wrong chart was used. And the error carries straight through, because Parkland is linear in burned area with no threshold and no curve. A scalded head and neck on an infant is 9 per cent on one chart and 18 on the other, so the fluid estimate is out by exactly a factor of two — at every body weight.
The other trap is the clock. The first half of the volume is due eight hours from the injury, not from arrival — so a three-hour transport leaves five hours for it and needs 1.60 times the rate. Start the clock at arrival instead and the fraction of the first half left undelivered at the eight-hour mark is exactly the delay divided by eight: 12.5 per cent at one hour, 37.5 at three, half at four. That is a closed form rather than an estimate, and it is the kind of thing a calculator can actually prevent.
Superficial burns are not counted at all. First-degree burns — sunburn being the classic case — are excluded from burned surface area entirely, and only partial and full thickness areas contribute. Including them inflates the fluid substantially: 15 superficial points added to a genuine 20 raises the estimate by 75 per cent. For scattered burns that no chart region describes, the patient's own palm including fingers is about one per cent of their surface — the patient's palm, not the assessor's, which matters most in exactly the paediatric cases where the charts already differ.
How to use
- Pick the chart that matches the patient, adult or paediatric.
- Score only partial and full thickness burns — superficial ones do not count.
- Enter hours since the injury, not since arrival.
- Treat the volume as a starting estimate to be titrated, never a prescription.
Frequently asked questions
What is the Rule of Nines?
A way of estimating burned body surface area from memory by dividing the body into regions worth nine per cent or multiples of it — head and neck nine, each arm nine, front and back of the trunk eighteen each, each leg eighteen, and one per cent for the perineum. It exists because it can be done at a scene without a chart, and it is an approximation rather than a measurement.
Why is the Rule of Nines different for children?
Because body proportions are different. An infant head is about eighteen per cent of body surface against an adult nine, and each leg about 13.5 against eighteen. Children are proportionally much more head and much less leg, and the difference is largest in infants, narrowing gradually through childhood until the adult figures apply.
What happens if I use the adult chart on a child?
You get a plausible-looking number that can be badly wrong, and this is the trap. The head gains nine points on the paediatric chart and the legs lose nine, so the two cancel exactly and both charts still total 100. Nothing about the total tells you the wrong chart was used — only comparing the regions does.
How much does the wrong chart change the fluid?
One for one, because the Parkland formula is linear in burned area with no threshold and no curve. Every percentage point is exactly four millilitres per kilogram. A scalded head and neck on an infant is nine per cent on the adult chart and eighteen on the paediatric one, so the fluid estimate comes out exactly double — at any body weight.
What is the Parkland formula?
Four millilitres of crystalloid per kilogram of body weight per per cent of burned surface area, over the first 24 hours, with half of that given in the first eight hours and the remainder over the following sixteen. It is a starting estimate to be titrated against urine output and clinical response, and modern practice frequently gives less than the classic figure.
When does the eight-hour clock start?
At the time of injury, not at the time of arrival or of starting fluids, and this is the error most worth preventing. A three-hour transport leaves five hours for the first half rather than eight, which needs 1.60 times the rate. Six hours of delay leaves two, needing four times the rate.
What happens if the clock is started at arrival by mistake?
The fraction of the first half left undelivered at the eight-hour mark is exactly the delay divided by eight — that falls straight out of the arithmetic rather than being an estimate. One hour of delay misses 12.5 per cent of the first half, three hours misses 37.5, and four hours misses exactly half of it.
Are superficial burns included in the burned area?
No, and including them is a common source of over-estimation. First-degree burns — sunburn is the classic example — are excluded from burned surface area entirely, and only partial and full thickness burns contribute. Adding fifteen superficial points to a genuine twenty raises the calculated fluid by seventy-five per cent.
How do I estimate scattered or irregular burns?
By palms. The patient own palm including the fingers is about one per cent of their body surface, so counting palms totals up patches that no chart region describes. It is the patient palm rather than the assessor palm, which matters most in exactly the paediatric cases where the two charts already disagree.
What is Lund-Browder and how is it different?
The age-graded standard, which assigns each region a value that changes continuously with age rather than switching between two charts. It is more accurate than the Rule of Nines, particularly in children, and correspondingly needs a chart to hand. The Rule of Nines exists for the situations where one is not.
How much fluid is that compared with blood volume?
A great deal, which is worth carrying as a sense of scale. Circulating blood volume is roughly seventy millilitres per kilogram, so a forty per cent burn in a seventy kilogram adult calls for about 2.3 times that patient entire blood volume over 24 hours, and an eighty per cent burn about 4.6 times. That is why burn resuscitation is monitored as closely as it is.
Can I use this while treating someone?
No. This is a study and teaching aid for people learning burn assessment. Parkland is a starting estimate titrated to urine output and clinical response rather than a prescription, the Rule of Nines is an approximation, and nothing here knows anything about a patient. Local protocol and the people at the bedside govern.
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