The statement “Any percentage exceeding 18% is an extensive burn” is partially correct, but it requires context and clarification. Let’s break it down properly.
Understanding Burn Classifications
Burns are typically classified by depth and extent:
- Depth (or degree):
- First-degree burns: Affect only the outer layer of the skin (epidermis), e.g., mild sunburn.
- Second-degree burns: Involve both the epidermis and part of the dermis.
- Third-degree burns: Destroy both layers and may affect underlying tissues.
- Extent (or surface area):
- Measured by the percentage of total body surface area (TBSA) affected.
- The “Rule of Nines” is commonly used for adults to estimate TBSA burned.
What Does “Extensive Burn” Mean?
The term “extensive burn” typically refers to a burn that covers a significant portion of the body and is potentially life-threatening or causes major systemic effects. However, the percentage considered “extensive” varies by age group, overall health, and medical guidelines.
General Guidelines:
- In adults, burns covering more than 20% TBSA are often considered major or extensive.
- In children and the elderly, even burns covering 10-15% TBSA can be critical due to their lower physiological reserves.
- The American Burn Association (ABA) defines a major burn as:
- Partial-thickness burns > 25% TBSA in adults.
- Full-thickness burns > 10% TBSA.
- Burns involving critical areas: face, hands, feet, genitalia, perineum, or major joints.
So, Is “More Than 18%” an Extensive Burn?
Yes and no. Here’s the nuance:
- Yes: If a burn exceeds 18% TBSA, especially if it’s a deep second-degree or third-degree burn, it’s certainly clinically significant and may be categorized as major/extensive, particularly in children or elderly patients.
- No: 18% TBSA is not always the universal cutoff for being labeled “extensive.” Some institutions might use 20% or more as the threshold for extensive or major burns in healthy adults.
Why Does This Matter?
Knowing whether a burn is “extensive” impacts:
- Hospital admission: Extensive burns usually require care in a burn center.
- Fluid resuscitation: Patients with >15-20% TBSA burns typically require IV fluids (per the Parkland formula).
- Infection risk: Larger burns carry higher risks of infection and sepsis.
- Prognosis and care planning: Extensive burns can lead to shock, organ failure, and need long-term rehabilitation.
Conclusion:
While 18% TBSA can be considered a significant burn, especially in sensitive populations, the term “extensive burn” is more commonly applied to cases where the TBSA burned is 20% or more in healthy adults. That said, clinical judgment, depth of the burn, and location are also vital in determining the severity.
So the revised statement would be:
“Any burn exceeding 18% of total body surface area may be considered extensive, particularly in children, the elderly, or if the burn is deep, but the general adult cutoff is closer to 20%.”