Burn classification

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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]


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.


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%


  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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