Burn classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Classification

The most common system of classifying burns categorizes them as first-, second-, or third-degree. Sometimes this is extended to include a fourth or even up to a sixth degree, but most burns are first- to third-degree, with the higher-degree burns typically being used to classify burns post-mortem. The following are brief descriptions of these classes:[1]

  • First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns only involve the epidermis.
  • Second-degree burns manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.
  • Third-degree burns occur when most of the epidermis is lost with damage to underlying ligaments, tendons and muscle. Burn victims will exhibit charring of the skin, and sometimes hard eschars will be present. An eschar is a scab that has separated from the unaffected part of the body. These types of burns are often considered painless, because nerve endings have been destroyed in the burned area. Hair follicles and sweat glands may also be lost due to complete destruction of the dermis. Third degree burns result in scarring and may be fatal if the affected area is significantly large. If extensive enough, it can increase the risk of infection, including bacterial, and can result in death.
  • Fourth-degree burns damage bone tissue and may result in a condition called compartment syndrome, which threatens both the life of the limb and the patient.
  • Fifth-degree burns are burns in which most of the hypodermis is lost, charring and exposing the muscle underneath. Sometimes, fifth-degree burns can be fatal.
  • Sixth-degree burns, the most severe form, are burn types in which almost all the muscle tissue in the area is destroyed, leaving almost nothing but charred bone. Often, sixth-degree burns are fatal.

Other Classifications

A newer classification of "Superficial Thickness", "Partial Thickness" (which is divided into superficial and deep categories) and "Full Thickness" relates more precisely to the epidermis, dermis and subcutaneous layers of skin and is used to guide treatment and predict outcome.

Table 1. A Description of the Traditional and Current Classifications of Burns

Nomenclature Traditional nomenclature Depth Clinical findings
Superficial thickness First-degree Epidermis involvement Erythema, minor pain, lack of blisters
Partial thickness — superficial Second-degree Superficial (papillary) dermis Blisters, clear fluid, and pain
Partial thickness — deep Second-degree Deep (reticular) dermis Whiter appearance, with decreased pain. Difficult to distinguish from full thickness
Full thickness Third- or fourth-degree Dermis and underlying tissue and possibly fascia, bone, or muscle Hard, leather-like eschar, purple fluid, no sensation (insensate)

Table 2. Scald Time (Hot Water)

Temperature Max duration until injury
155F (68.3C) 1 second
145F (62.9C) 3 seconds
135F (57.2C) 10 seconds
130F (54.4C) 30 seconds
125F (51.6C) 2 minutes
120F (48.8C) 5 minutes

Burns can also be assessed in terms of total body surface area (TBSA), which is the percentage affected by partial thickness or full thickness burns (superficial thickness burns are not counted). The rule of nines is used as a quick and useful way to estimate the affected TBSA.

Table 3. Rule of Nines for Assessment of Total Body Surface Area Affected by a Burn - Adult
Anatomic Structure Surface Area
Head 9%
Anterior Torso 18%
Posterior Torso 18%
Each Leg 18%
Each Arm 9%
Perineum 1%
Table 4. Rule of Nines for Assessment of Total Body Surface Area Affected by a Burn - Infant
Anatomic Structure Surface Area
Head 18%
Anterior Torso 18%
Posterior Torso 18%
Each Leg 14%
Each Arm 9%
Perineum 1%

References

  1. Burn Degrees Lifespan.com Accessed February 24, 2008



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