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{{Burn}}
{{Burn}}
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{{CMG}}'''Associate Editor(s)-in-Chief:''' {{EAM}}
 
<br />
 
==Overview==
[[Burns]] may be classified according to severity into first, second and third degree [[Burn (injury)|burn]] injury. It may also be classified based on [[superficial]] and deep  categories into  "[[Superficial Thickness]]" , "[[Partial Thickness]]" of burns.<br />
==Classification==
==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:<ref> Burn Degrees [http://www.lifespan.org/services/criticalcare/articles/burns/burns.htm Lifespan.com] Accessed February 24, 2008</ref>'''The basis of burn classification is depth. When examining a burn, there are four components needed to assess depth: appearance, blanching to pressure, pain, and sensation.'''<ref name="pmid27752547">Toussaint J, Singer AJ (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27752547 The evaluation and management of thermal injuries: 2014 update.] ''Clin Exp Emerg Med'' 1 (1):8-18. [http://dx.doi.org/10.15441/ceem.14.029 DOI:10.15441/ceem.14.029] PMID: [https://pubmed.gov/PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/cee PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/cee]</ref> '''Burns can be categorized by thickness according to the American Burn Criteria using those four elements. Burn injuries tend to be a dynamic process. Some burns, especially partial-thickness, may progress over 2 to 4 days, peaking at day 3.'''<ref name="pmid20629737">Evers LH, Bhavsar D, Mailänder P (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20629737 The biology of burn injury.] ''Exp Dermatol'' 19 (9):777-83. [http://dx.doi.org/10.1111/j.1600-0625.2010.01105.x DOI:10.1111/j.1600-0625.2010.01105.x] PMID: [https://pubmed.gov/PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105]</ref>


*'''First-degree burns(Partial Thickness Superficial)''' are usually limited to redness ([[erythema]]), a white plaque and minor [[pain]] at the site of injury. These burns only involve the [[Epidermis (skin)|epidermis]] of the skin.<ref name="pmid29369586">Tolles J (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29369586 Emergency department management of patients with thermal burns.] ''Emerg Med Pract'' 20 (2):1-24. PMID: [https://pubmed.gov/PMID: 29369586 PMID: 29369586]</ref>'''<ref name="pmid20629737">Evers LH, Bhavsar D, Mailänder P (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20629737 The biology of burn injury.] ''Exp Dermatol'' 19 (9):777-83. [http://dx.doi.org/10.1111/j.1600-0625.2010.01105.x DOI:10.1111/j.1600-0625.2010.01105.x] PMID: [https://pubmed.gov/PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105]</ref>'''
 
*'''Second-degree burns(Superficial partial-thickness)''' manifest as erythema with superficial [[blister]]ing 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'''. It appears red with blisters and is wet. The erythema blanches with pressure. The pain associated with superficial partial-thickness is severe. Healing typically occurs within 3 weeks with minimal scarring.'''<ref name="pmid29369586">Tolles J (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29369586 Emergency department management of patients with thermal burns.] ''Emerg Med Pract'' 20 (2):1-24. PMID: [https://pubmed.gov/PMID: 29369586 PMID: 29369586]</ref>'''<ref name="pmid20629737">Evers LH, Bhavsar D, Mailänder P (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20629737 The biology of burn injury.] ''Exp Dermatol'' 19 (9):777-83. [http://dx.doi.org/10.1111/j.1600-0625.2010.01105.x DOI:10.1111/j.1600-0625.2010.01105.x] PMID: [https://pubmed.gov/PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105]</ref>'''
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:<ref name="pmid9115481">{{cite journal |vauthors=Mertens DM, Jenkins ME, Warden GD |title=Outpatient burn management |journal=Nurs Clin North Am |volume=32 |issue=2 |pages=343–64 |date=June 1997 |pmid=9115481 |doi= |url=}}</ref>The basis of [[Burn (injury)|burn]] [[classification]] is depth. When examining a [[Burn (injury)|burn]], there are four components needed to assess depth: appearance, blanching to [[pressure]], [[pain]], and [[sensation]].<ref name="pmid27752547">Toussaint J, Singer AJ (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=27752547 The evaluation and management of thermal injuries: 2014 update.] ''Clin Exp Emerg Med'' 1 (1):8-18. [http://dx.doi.org/10.15441/ceem.14.029 DOI:10.15441/ceem.14.029] PMID: [https://pubmed.gov/PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/cee PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/cee]</ref> [[Burns]] can be categorized by thickness according to the American [[Burn (injury)|Burn]] Criteria using those four elements. [[Burn (injury)|Burn]] injuries tend to be a dynamic process. Some burns, especially partial-thickness, may progress over 2 to 4 days, peaking at day 3.<ref name="pmid20629737">Evers LH, Bhavsar D, Mailänder P (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20629737 The biology of burn injury.] ''Exp Dermatol'' 19 (9):777-83. [http://dx.doi.org/10.1111/j.1600-0625.2010.01105.x DOI:10.1111/j.1600-0625.2010.01105.x] PMID: [https://pubmed.gov/PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105]</ref>
*'''Deep partial-thickness (second-degree) involves the deeper dermis. It appears yellow or white, is dry, and does not blanch with pressure. There is minimal pain due to a decreased sensation. Healing occurs in 3 to 8 weeks with scarring present'''.
 
*'''Third-degree burns(full thickness)''' 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. '''Third-degree involves the full thickness of skin and subcutaneous structures. It appears white or black/brown. With pressure, no blanching occurs. The burn is leathery and dry. There is minimal to no pain because of decreased sensation. Full-thickness burns heal by contracture and take greater than 8 weeks. Full-thickness burns require skin grafting.'''
*First-degree burns(Partial Thickness Superficial) are usually limited to [[redness]] ([[erythema]]), a white [[plaque]] and minor [[pain]] at the site of [[injury]]. These [[burns]] only involve the [[epidermis]] of the [[skin]].<ref name="pmid29369586">Tolles J (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29369586 Emergency department management of patients with thermal burns.] ''Emerg Med Pract'' 20 (2):1-24. PMID: [https://pubmed.gov/PMID: 29369586 PMID: 29369586]</ref><ref name="pmid20629737">Evers LH, Bhavsar D, Mailänder P (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20629737 The biology of burn injury.] ''Exp Dermatol'' 19 (9):777-83. [http://dx.doi.org/10.1111/j.1600-0625.2010.01105.x DOI:10.1111/j.1600-0625.2010.01105.x] PMID: [https://pubmed.gov/PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105]</ref>
*'''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.'''charred skin with possible exposed bone.'''
*Second-degree [[burns]](Superficial partial-thickness) manifest as [[erythema]] (red) which blanches with [[pressure]], with superficial blistering and wet 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.So the [[pain]] associated with superficial partial-thickness is severe. [[Healing]] typically occurs within 3 weeks with minimal [[scarring]].<ref name="pmid29369586">Tolles J (2018) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=29369586 Emergency department management of patients with thermal burns.] ''Emerg Med Pract'' 20 (2):1-24. PMID: [https://pubmed.gov/PMID: 29369586 PMID: 29369586]</ref><ref name="pmid20629737">Evers LH, Bhavsar D, Mailänder P (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20629737 The biology of burn injury.] ''Exp Dermatol'' 19 (9):777-83. [http://dx.doi.org/10.1111/j.1600-0625.2010.01105.x DOI:10.1111/j.1600-0625.2010.01105.x] PMID: [https://pubmed.gov/PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105]</ref>
*'''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.charred, '''white skin, and exposed bone.'''
*Deep partial-thickness (second-degree) involves the deeper [[dermis]]. It appears yellow or white, is dry, and does not blanch with [[pressure]]. There is minimal [[pain]] due to a decreased sensation. [[Healing]] occurs in 3 to 8 weeks with [[scarring]] present.
*'''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.'''''loss of skin with exposed bone'''''.
*Third-degree [[burns]](full thickness) 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. Third-degree involves the [[full thickness of skin]] and [[subcutaneous]] structures. It appears white or black/brown. With [[pressure]], no blanching occurs. The burn is leathery and dry. There is minimal to no pain because of decreased sensation. [[Full-thickness burns]] heal by contracture and take greater than 8 weeks. [[Full-thickness burns]] require [[skin grafting]].
*'''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. '''[[charred skin]] with possible exposed bone.'''
*'''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 .charred, '''white skin, and exposed bone.'''
*'''Sixth-degree burns''', the most severe form, are [[Burn (injury)|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. loss of [[skin]] with exposed [[bone]].


===Other Classifications===
===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.<ref name="urlBurn Classification - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK539773/ |title=Burn Classification - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
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.<ref name="pmid206297372">{{cite journal |vauthors=Evers LH, Bhavsar D, Mailänder P |title=The biology of burn injury |journal=Exp Dermatol |volume=19 |issue=9 |pages=777–83 |date=September 2010 |pmid=20629737 |doi=10.1111/j.1600-0625.2010.01105.x |url=}}</ref>


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


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Latest revision as of 18:25, 7 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]


Overview

Burns may be classified according to severity into first, second and third degree burn injury. It may also be classified based on superficial and deep categories into "Superficial Thickness" , "Partial Thickness" of burns.

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]The basis of burn classification is depth. When examining a burn, there are four components needed to assess depth: appearance, blanching to pressure, pain, and sensation.[2] Burns can be categorized by thickness according to the American Burn Criteria using those four elements. Burn injuries tend to be a dynamic process. Some burns, especially partial-thickness, may progress over 2 to 4 days, peaking at day 3.[3]

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.[5]

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

Template:Bgcolor-gold |Nomenclature Template:Bgcolor-gold |Traditional nomenclature Template:Bgcolor-gold |Depth Template:Bgcolor-gold |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)

Template:Bgcolor-gold |Temperature Template:Bgcolor-gold |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
Template:Bgcolor-gold |Anatomic Structure Template:Bgcolor-gold |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
Template:Bgcolor-gold |Anatomic Structure Template:Bgcolor-gold |Surface Area
Head 18%
Anterior Torso 18%
Posterior Torso 18%
Each Leg 14%
Each Arm 9%
Perineum 1%

References

  1. Mertens DM, Jenkins ME, Warden GD (June 1997). "Outpatient burn management". Nurs Clin North Am. 32 (2): 343–64. PMID 9115481.
  2. Toussaint J, Singer AJ (2014) The evaluation and management of thermal injuries: 2014 update. Clin Exp Emerg Med 1 (1):8-18. DOI:10.15441/ceem.14.029 PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/cee PMID: 27752547 PMCID: PMC5052819 DOI: 10.15441/cee
  3. 3.0 3.1 3.2 Evers LH, Bhavsar D, Mailänder P (2010) The biology of burn injury. Exp Dermatol 19 (9):777-83. DOI:10.1111/j.1600-0625.2010.01105.x PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105 PMID: 20629737 DOI: 10.1111/j.1600-0625.2010.01105
  4. 4.0 4.1 Tolles J (2018) Emergency department management of patients with thermal burns. Emerg Med Pract 20 (2):1-24. PMID: 29369586 PMID: 29369586
  5. Evers LH, Bhavsar D, Mailänder P (September 2010). "The biology of burn injury". Exp Dermatol. 19 (9): 777–83. doi:10.1111/j.1600-0625.2010.01105.x. PMID 20629737.

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