lund and browder chart

3 min read 18-03-2025

The Lund and Browder chart is a crucial tool in assessing the extent and severity of burns. Understanding its use is vital for healthcare professionals involved in burn care. This chart provides a precise method for calculating the total body surface area (TBSA) affected by burns, a critical factor in determining treatment and prognosis. Accurate assessment using this chart is the first step towards effective burn management.

What is the Lund and Browder Chart?

The Lund and Browder chart is a diagram that divides the body into specific regions, each representing a percentage of the total body surface area (TBSA). Unlike the simpler Rule of Nines, the Lund and Browder chart accounts for age-related differences in body proportions. This is especially important in children, where the head and neck represent a larger percentage of TBSA compared to adults.

Advantages over the Rule of Nines

Age-Specific Percentages: The primary advantage is its accuracy in calculating TBSA for both adults and children. The proportions of body regions change significantly with age, and the Lund and Browder chart reflects this variability.
Greater Precision: The detailed anatomical divisions offer a more precise estimation of burn size compared to the broader estimations provided by the Rule of Nines.
Improved Assessment of Complex Burns: The chart facilitates a more accurate assessment of irregularly shaped or partial-thickness burns, which can be challenging to estimate using other methods.

How to Use the Lund and Browder Chart

Using the chart is straightforward but requires careful attention to detail. Here's a step-by-step guide:

Identify the Burn Type: Determine whether the burn is a partial-thickness (superficial or deep partial-thickness) or full-thickness burn. This influences treatment decisions.
Locate the Corresponding Chart: Select the chart appropriate for the patient's age (separate charts exist for infants, children, and adults).
Outline Burn Areas: Carefully trace the outline of each burned area on the chart. Be precise and include all affected regions, even small ones.
Calculate the Percentage: Add up the percentages of the burned regions to obtain the total TBSA affected.
Document Findings: Record the calculated TBSA, the burn type(s), and any other relevant information in the patient's medical record.

Interpreting the Results: What the Lund and Browder Chart Tells Us

The TBSA percentage calculated using the Lund and Browder chart is a critical piece of information in burn management. It helps clinicians:

Assess Burn Severity: The percentage of TBSA affected directly correlates with the severity of the burn injury. Larger TBSA burns often indicate a more significant risk of complications.
Guide Treatment Decisions: The TBSA is crucial in determining the need for fluid resuscitation, surgical intervention (e.g., escharotomy, grafting), and the intensity of pain management.
Predict Prognosis: The extent of the burn influences the patient's recovery time, potential for scarring, and the likelihood of complications such as infection and sepsis.
Resource Allocation: Hospitals use TBSA data for allocating resources, including beds, staff, and supplies.

Beyond the Chart: Other Important Factors in Burn Management

While the Lund and Browder chart is an indispensable tool, it’s essential to remember that TBSA is only one factor in determining burn severity. Other critical factors include:

Burn Depth: Full-thickness burns are more severe than partial-thickness burns.
Location of Burns: Burns to the face, hands, feet, perineum, and major joints carry a higher risk of complications.
Patient's Overall Health: Pre-existing medical conditions can significantly affect the patient's response to burn injury.
Inhalation Injury: Smoke inhalation can cause significant lung damage, further complicating the burn injury.

Conclusion

The Lund and Browder chart remains a cornerstone of burn assessment. Its age-specific design makes it a more accurate and reliable tool compared to the Rule of Nines, particularly in children. However, clinicians should use the chart in conjunction with a thorough clinical evaluation, considering all relevant factors to provide optimal burn care. Accurate and timely assessment using the Lund and Browder chart contributes significantly to improving patient outcomes in burn management.