II. Epidemiology
- U.S. Incidence of Burn Injury
- Emergency Department visits: 500,000 per year
- Hospitalizations: 40,000 per year (60% require burn center admission)
- Ages at higher risk of Burn Injury (bimodal distribution)
- Children
- Older adults
III. Causes
- Scald Burn (80% of burns in young children)
- Hot liquids pulled off the counter
- Flame-related burns (more common in school age children and teens)
- Lighters
- Lighter fluid
- Fireworks
- Gasoline
IV. Pathophysiology
- Deep dermal injury
- Disrupts elasticity, mechanical barrier protection and vascular supply
- Results in scarring and Non-Healing Wounds
V. Precautions
- Consider physical abuse
- Intimate Partner Violence
- Elder Abuse
- Nonaccidental Trauma in children with Burn Injury
- Physical abuse accounts for 5-6% of Burn Injury <12 years old
- Social workers typically review pediatric burns at burn centers and pediatric hospitals
- Involve child protective services and pediatric specialty center evaluation if suspected abuse
- Consider in delayed presentation, parental indifference and inconsistent history
- Consider in burns to hands or feet, buttocks or posterior legs
- Consider in well demarcated burns or linear or patterned burns
- Consider in symmetric burns and in those that do not spare the flexor crease
- Evaluate for other Traumatic Injury
VI. Types
- Electrical Injury
- Lightning Injury
- Chemical Toxin
- Fire-Related Injury
- Thermal Burn
- Contact with hot surface and scald burns from liquid (>111 F, 43 C) account for 85% of pediatric burns
- Smoke Inhalation
- Occurs in 5-35% of hospitalized Burn Injury patients
- Acute airway compromise (airway edema)
- Carbon Monoxide Poisoning
- Cyanide Poisoning
- Thermal Burn
VII. Signs: Burn Degree
- Precaution
- Conversion to deeper burn may occur over ensuing days after initial injury
- First degree (Superficial burn)
- Second degree (Partial thickness burn)
- Superficial partial thickness
- Pathophysiology
- Findings
- Wet, weaping lesions with clear Blisters
- Erythematous, soft skin that blanches with pressure
- When touched, skin is hypersensitive and painful
- Course
- Healing occurs within 14-21 days
- Scarring is possible but uncommon (deeper structures including stem cells are spared)
- Deep partial thickness
- Pathophysiology
- Findings
- Drier lesions than with superficial partial thickness
- White or pale to Yellow Skin that when touched does not blanch (or has decreased blanching)
- Hemorrhagic Blisters may be present
- Painful despite reduced Sensation to touch
- Skin is slightly tense (less soft than in superficial partial thickness burns)
- Course
- Healing typically takes >21 days
- Scarring and contractures are common complications (involves stem cells, follicles, glands)
- Benefits from early evaluation by burn surgeon early operative management
- Superficial partial thickness
- Third degree (Full thickness)
- Pathophysiology
- Kills all skin layers (involves all of Dermis)
- Also involves underlying subcutaneous fat and connective tissue
- Findings
- Waxy, dark-brown to black, tan or white skin
- Skin is stiff and leatherlike (contrast with soft skin of superficial burns)
- Bright red burns without blanching or Sensation are Third Degree Burns (contrast with pink Second Degree Burns)
- No Sensation to touch
- No Capillary Refill
- Course
- Burn center evaluation indicated in all cases
- Typically do not heal without skin grafting
- Contractures are a common complication
- Pathophysiology
- Fourth degree
- Destroys all skin layers
- Also involves Muscle, tendon or bone
VIII. Signs: Estimating Surface Area with Rule of 9's
- Precautions
- Estimate burn area only based on second and Third Degree Burns
- First Degree Burns do not count for calculation (Sunburn-like red, closed injury areas)
- Exercise caution in burn area calculation in children (overestimated by >200%)
- Can substantially affect fluid Resuscitation volume calculation (Parkland Formula)
- Goverman (2015) J Burn Care Res 36(5): 574-9 +PMID:25407387 [PubMed]
- Lund and Bowder Chart offers a more accurate assessment of burn area
- Estimate burn area only based on second and Third Degree Burns
- Infant Rule of 9s
- Head: 18%
- Torso Back: 18%
- Torso Front: 18%
- Leg Left: 14%
- Leg Right: 14%
- Arm Left: 9%
- Arm Right: 9%
- Adult Rule of 9s
- Torso Front: 18%
- Torso Back: 18%
- Leg Left: 18%
- Leg Right: 18%
- Head: 9%
- Arm Left: 9%
- Arm Right: 9%
- Genitalia: 1%
- Size of patients palm
- Entire palm and fingers: 1% TBSA (inaccurate in obese patients)
- Palm only: 0.5% TBSA
- Resources
- EasyTBSA
- Iphone/Android App - Calculate Body surface area in Burn Injury
- https://apps.apple.com/us/app/easytbsa/id1554943740
- https://play.google.com/store/apps/details?id=org.cnmc.EasyTBSA&hl=en_US&gl=US
- EasyTBSA
IX. Evaluation: Minor burn criteria
- Burn is not circumferential
- Burn is only injury
- Burn does not involve high risk areas
- Across major joints
- Face
- Hands or feet
- Perineum or genitalia
- Partial thickness burn surface area is limited (Second Degree Burn area)
- Ages 10 to 50 years old: Burn area <10%
- Age under 10 or over age 50 years old: Burn area <5% (<2% third degree, full thickness)
X. Management
- See Burn Management
XI. Prevention: General
- See Sunscreen
- Avoid Smoking inside the home
XII. Prevention: Burns in Children
- Consider Nonaccidental Trauma, Intimate Partner Violence or Elder Abuse (see precautions as above)
- Bath
- Test bathwater before placing child in bath
- Set hot water heater to lowest setting (below 120 degrees F)
- Monitor children continuously when in the bath or near faucets
- Kitchen
- Preferentially use the back Burners of the stove when cooking in the presence of children
- Household
- Test smoke alarms on a regular basis
- Monitor children when near fireplace
- Keep children away from matches, fireworks, gasoline and explosives
- Keep children away from hot objects
- Never hold children while working with hot objects
XIII. Prognosis: Increased mortality risk factors
- Age >60 years
- Associated Smoke Inhalation
XIV. References
- Mason and Yowler in Herbert (2016) EM:Rap 16(4):4-5
- Weir (2020) Crit Dec Emerg Med 34(12): 3-11
- Nemri and Fairbrother (2021) Crit Dec Emerg Med 35(9): 3-10
- Cuttle (2009) Burns 35(6): 768-75 [PubMed]
- Grunwald (2008) Plast Reconstr Surg 121(5): 311e-9e [PubMed]
- Hettiaratchy (2004) BMJ 328(7452): 1366-8 [PubMed]
- Lanham (2020) Am Fam Physician 101(8): 463-70 [PubMed]
- Lloyd (2012) Am Fam Physician 85(1): 25-32 [PubMed]
- Roberts (2003) Emerg Med News 25(3): 28-31 [PubMed]
- Sheridan (2005) Emerg Care 21(7): 449-56 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MEDLINEPLUS) |
A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight or radiation. Scalds from hot liquids and steam, building fires and flammable liquids and gases are the most common causes of burns. Another kind is an inhalation injury, caused by breathing smoke. There are three types of burns:
Burns can cause swelling, blistering, scarring and, in serious cases, shock and even death. They also can lead to infections because they damage your skin's protective barrier. Antibiotic creams can prevent or treat infections. After a third-degree burn, you need skin or synthetic grafts to cover exposed tissue and encourage new skin to grow. First- and second-degree burns usually heal without grafts. NIH: National Institute of General Medical Sciences |
| Definition (SCTSPA) | Lesión genérica por quemadura, incluidas las producidas por calor excesivo, así como por cauterización, fricción, electricidad, radiación, luz solar y otras causas |
| Definition (SNOMEDCT_US) | Generic burn injury, including that due to excessive heat, as well as cauterization, friction, electricity, radiation, sunlight, and other causes |
| Definition (NCI) | A traumatic injury involving interruption of tissue cohesiveness that results from exposure to caustic chemicals, extreme heat, extreme cold or excessive radiation. |
| Definition (NCI_CTCAE) | A finding of impaired integrity to the anatomic site of an adverse thermal reaction. Burns can be caused by exposure to chemicals, direct heat, electricity, flames and radiation. The extent of damage depends on the length and intensity of exposure and time until provision of treatment. |
| Definition (NCI_FDA) | Injury to tissues caused by contact with dry heat, moist heat, flames, chemicals, electricity, friction or radiant and electromagnetic energy. A first degree burn is associated with redness, a second degree burn with vesication and a third degree burn with necrosis through the entire skin. |
| Definition (MSH) | Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. |
| Definition (CSP) | damage inflicted on any part of an organism as the direct or indirect result of exposure to steam, chemicals, heat, flame, electricity or the like, with or without disruption of structural continuity; for burns due to overexposure to the sun use SUNBURN. |
| Concepts | Injury or Poisoning (T037) |
| MSH | D002056 |
| ICD9 | 949.0, 940-949.99 |
| ICD10 | T20-T31.9 , T30.0 |
| SnomedCT | 157629005, 212129000, 212138003, 212139006, 269386003, 211657006, 48333001, 125666000 |
| LNC | LP7090-6, MTHU007829, LA7318-4 |
| English | Burn injury, Burns, BURN, Burn of unspecified site, unspecified degree, Burns NOS, Burn - unspecified, burns (physical finding), burns, burn, burn (diagnosis), Burn NOS, Burns [Disease/Finding], burning disorders, burn injury, burning injuries, burns injuries, burn injuries, burns injury, burned, burnings, burning lesions, burn lesion, Burn Wound, Burn - unspecified (disorder), Burns NOS (disorder), BURN(S), Burn, Burn - lesion, Burn (disorder), Burn injury (morphologic abnormality), Burn injury, NOS, Burn, NOS, BURNS |
| French | BRULURE, Brûlures SAI, Brûlure, Brûlure de site non précisé, de degré non précisé, Brûlures |
| Dutch | brandwonden NAO, brandwond van niet-gespecificeerde plaats, niet-gespecificeerde graad, brandwond, Brandwond, Brandwonden, Wond, brand-, Wonden, brand- |
| German | Verbrennung, Verbrennungen NNB, Vergrennung an einer unspezifischen Stelle, unspezifischer Grad, Verbrennungen |
| Italian | Ustioni NAS, Ustione, Ustione in sede non specificata di grado non specificato, Ustioni |
| Portuguese | Queimadura de localização NE de grau NE, Queimadura, Queimaduras NE, QUEIMADURA, Queimaduras |
| Spanish | Quemadura de localización no especificada, grado no especificado, Quemaduras NEOM, Quemadura, quemadura - no especificada (trastorno), quemadura - no especificada, quemaduras, SAI (trastorno), Burns NOS, quemaduras, SAI, Burn - unspecified, lesión traumática por quemadura (anomalía morfológica), lesión traumática por quemadura, quemadura (trastorno), quemadura - lesión, quemadura, Quemaduras |
| Japanese | 熱傷ＮＯＳ, 熱傷, 熱傷、程度不明, ﾈﾂｼｮｳNOS, ﾈｯｼｮｳ, ﾈｯｼｮｳNOS, ﾈｯｼｮｳﾃｲﾄﾞﾌﾒｲ |
| Swedish | Brännskador |
| Czech | popálení, opaření, Popálenina, Popálenina blíže neurčeného stupně, blíže neurčeného místa, Popáleniny NOS, spáleniny, poleptání, popáleniny |
| Finnish | Palovammat |
| Russian | OZHOGI, ОЖОГИ |
| Croatian | OPEKLINE |
| Polish | Oparzenia |
| Hungarian | Nem meghatározott lokalizációjú és nem meghatározott fokú égés, Égések k.m.n., Égés |
| Norwegian | Brannskader, Forbrenninger, Brannsår, Combustio |
Ontology: Thermal injury (C0332685)
| Definition (SCTSPA) | Lesión traumática debida a calor intenso |
| Definition (SNOMEDCT_US) | Injury due to increased heat |
| Definition (CSP) | damage inflicted on any part of an organism as the direct or indirect result of exposure to a high temperature, with or without disruption of structural continuity. |
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 161006 |
| English | heat injury, thermal injuries, heat injuries, thermal injury, injuries heat, injuries thermal, Heat injury, Thermal injury (morphologic abnormality), Thermal injury, Heat injury, NOS, Thermal injury, NOS |
| Spanish | injuria por calor, injuria térmica, lesión por calor, lesión traumática térmica (anomalía morfológica), lesión traumática térmica |
Ontology: First degree burn (C0332686)
| Definition (NCI_FDA) | A burn that only affects the outer layer of skin causing pain, redness, and swelling. |
| Definition (NCI) | A painful injury to the epidermis due to chemical, friction, radiation or thermal exposure. The affected area appears red and blanches when touched. |
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 949.1 |
| ICD10 | T30.1 |
| SnomedCT | 269248005, 212131009, 77140003, 403190006 |
| English | Erythema due to burn (first degree), unspecified site, Burn of first degree, body region unspecified, Superficial burn NOS, first degree burns, first degree burns (diagnosis), superficial (first degree) burns, Burns first degree, First degree burns, First-Degree Burn, 1st degree burn NOS, Erythema, body region unspecified, burns superficial, superficial burn, burn degree first, first degree burn, burns degree first, Erythema [first degree], unspecified site, Erythema due to burn [first degree], unspecified site, (First degree burn) or (superficial burn NOS), Superficial burn NOS (disorder), (First degree burn) or (superficial burn NOS) (disorder), First Degree Burn, FIRST-DEGREE BURN, Burn erythema, Erythema caloricum, First degree burn injury, Superficial burn, First degree burn, First degree burn (disorder), First degree burn injury (morphologic abnormality), Erythema due to first degree burn, unspecified site, Erythema due to burn, unspecified site |
| Italian | Ustioni di primo grado, Ustione superficiale, Eritema secondario ad ustione (primo grado), sede non specificata |
| Dutch | erytheem door brandwond (eerste graad), niet-gespecificeerde plaats, brandwond oppervlakkig, eerstegraadsbrandwonden, Brandwond van eerste graad, lichaamsregio niet gespecificeerd, brandwonden eerste graad |
| French | Erythème lié à une brûlure (premier degré), site non précisé, Brûlure superficielle, Brûlures du premier degré |
| German | Erythem verursacht durch Verbrennung (ersten Grades), unspezifische Stelle, oberflaechliche Verbrennung, Verbrennung 1. Grades, Koerperregion nicht naeher bezeichnet, Verbrennungen ersten Grades |
| Portuguese | Eritema por queimadura (1º grau) de local NE, Queimadura superficial, Queimaduras do 1º grau |
| Spanish | Eritema por quemadura (de primer grado), localización no especificada, Quemadura superficial, quemadura superficial, SAI (trastorno), quemadura superficial, SAI, eritema calórico, eritema por quemadura, quemadura de primer grado (anomalía morfológica), quemadura de primer grado (trastorno), quemadura de primer grado, Quemaduras de primer grado |
| Japanese | 第１度熱傷, （第１度）熱傷による紅斑、部位不明, 表在性熱傷, ﾀﾞｲ1ﾄﾞﾈｯｼｮｳﾆﾖﾙｺｳﾊﾝﾌﾞｲﾌﾒｲ, ﾀﾞｲ1ﾄﾞﾈｯｼｮｳ, ﾋｮｳｻﾞｲｾｲﾈｯｼｮｳ |
| Czech | Povrchová popálenina, Popáleniny prvního stupně, Popálenina prvního stupně, erytém blíže neurčeného místa |
| Korean | 상세불명 신체 부위의 1도 화상 |
| Hungarian | Felületes égés, Első fokú égések, Nem meghatározott lokalizációjú, égés okozta (első fokú) erythema |
Ontology: Second degree burn (C0332687)
| Definition (NCI) | An injury that includes the entire epidermis and upper layers of the dermis due to a chemical, friction, radiation or thermal exposure. The affected area appears as moist red or white skin that does not blanch. Often it is painful with the presence of blisters. |
| Definition (NCI_FDA) | A partial thickness burn that affects both the outer and underlying layer of skin causing pain, redness, swelling and blistering. |
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 949.2 |
| SnomedCT | 212132002, 46541008, 403191005 |
| English | Blisters with epidermal loss due to burn (second degree), unspecified site, second degree burns (diagnosis), second degree burns, partial thickness (second degree) burns, Burns second degree, Second degree burns, Second-Degree Burn, 2nd degree burn NOS, burns degree second, burn degree second, second degree burn, burn second degree, Blisters with epidermal loss due to burn [second degree], unspecified site, Blisters, epidermal loss [second degree], unspecified site, SECOND-DEGREE BURN, Second Degree Burn, Burn blister with epidermal loss, Second degree burn injury, Second degree burn, Second degree burn (disorder), Second degree burn injury (morphologic abnormality), Blisters with epidermal loss due to second degree burn, unspecified site, Blisters with epidermal loss due to burn, unspecified site |
| Italian | Ustioni di secondo grado, Vescicole con perdita dell'epidermide da ustione (secondo grado), sede non specificata |
| Dutch | brandblaar met epidermale beschadiging (tweede graad) van niet-gespecificeerde plaats, tweedegraadsbrandwonden, brandwonden tweede graad |
| French | Brûlures du second degré, Phlyctènes avec perte épidermique liées à une brûlure (second degré), site non précisé, Brûlures du deuxième degré |
| German | Blasen mit Hautverlust durch Verbrennung (zweiten Grades), unspezifische Stelle, Verbrennungen zweiten Grades |
| Portuguese | Bolhas com perda de epiderme por queimadura (2º grau) de localização NE, Queimaduras do 2º grau |
| Spanish | Ampollas con pérdida epidérmica por quemadura (de segundo grado), localización no especificada, quemadura con destrucción epidérmica, quemadura con pérdida epidérmica, quemadura de segundo grado (anomalía morfológica), quemadura de segundo grado (trastorno), quemadura de segundo grado, Quemaduras de segundo grado |
| Japanese | 第２度熱傷, （第２度）熱傷による表皮欠損を伴う水疱形成、部位不明, ﾀﾞｲ2ﾄﾞﾈｯｼｮｳﾆﾖﾙﾋｮｳﾋｹｯｿﾝｦﾄﾓﾅｳｽｲﾎｳｹｲｾｲﾌﾞｲﾌﾒｲ, ﾀﾞｲ2ﾄﾞﾈｯｼｮｳ |
| Czech | Popálenina druhého stupně, puchýře se ztrátou epidermis, blíže neurčeného místa, Popáleniny druhého stupně |
| Hungarian | Másodfokú égések, Nem meghatározott lokalizációjú terület (másodfokú) égés okozta felhólyagosodása epiderm. hiánnyal |
Ontology: Third degree burn (C0433445)
| Definition (NCI) | An injury that includes all skin layers into the subcutaneous tissue due to chemical, friction, radiation or thermal exposure. The affected area appears dry and thickened; damage to nerve endings usually renders the wound painless. |
| Definition (NCI_FDA) | A full thickness burn that extends into deeper tissues causing white or blackened and charred skin that may be numb. |
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 212135000, 269250002, 80247002, 403192003 |
| English | Full thickness burn NOS, third degree burns (diagnosis), third degree burns, full thickness (third degree) burns, Burns third degree, Third degree burns, Third-Degree Burn, third degree burn, burn degree third, full thickness burn, burns full thickness, burns degree third, Full thickness burn NOS (disorder), (Third degree burn) or (full thickness burn NOS) (disorder), (Third degree burn) or (full thickness burn NOS), Third Degree Burn, THIRD-DEGREE BURN, Burn with full-thickness skin loss, Third degree burn injury, FT - Full thickness burn, Full thickness burn, Third degree burn, Third degree burn (disorder), Third degree burn injury (morphologic abnormality) |
| Italian | Ustioni di terzo grado |
| Dutch | derdegraadsbranwonden, brandwonden derde graad |
| Japanese | 第３度熱傷, ﾀﾞｲ3ﾄﾞﾈｯｼｮｳ |
| Czech | Popáleniny třetího stupně |
| Hungarian | Harmadfokú égés, Harmadfokú égések |
| Spanish | quemadura de tercer grado, SAI (trastorno), quemadura de tercer grado, SAI, quemadura con pérdida del espesor total de la piel, quemadura de tercer grado (anomalía morfológica), quemadura de tercer grado (trastorno), quemadura de tercer grado, Quemaduras de tercer grado |
| Portuguese | Queimaduras do 3º grau |
| French | Brûlures du troisième degré |
| German | Verbrennungen dritten Grades |
Ontology: Burn of second degree, body region unspecified (C0496071)
| Concepts | Injury or Poisoning (T037) |
| ICD10 | T30.2 |
| English | Burn of second degree, body region unspecified, Burn of partial thicknes, body region unspecified |
| German | Verbrennung 2. Grades, Koerperregion nicht naeher bezeichnet |
| Korean | 상세불명 신체 부위의 2도 화상 |
| Dutch | Brandwond van tweede graad, lichaamsregio niet gespecificeerd |
Ontology: Burn of third degree, body region unspecified (C0496072)
| Concepts | Injury or Poisoning (T037) |
| ICD10 | T30.3 |
| English | Burn of third degree, body region unspecified, Burn of full thickness, body region unspecified |
| German | Verbrennung 3. Grades, Koerperregion nicht naeher bezeichnet |
| Korean | 상세불명 신체 부위의 3도 화상 |
| Dutch | Brandwond van derde graad, lichaamsregio niet gespecificeerd |
Ontology: Thermal burn (C0701836)
| Definition (SCTSPA) | Quemadura debida a calor excesivo |
| Definition (SNOMEDCT_US) | Burn injury due to excessive heat |
| Definition (NCI) | A burn injury caused by heat or fire. |
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 105594005, 314534006, 48333001 |
| Italian | Ustione da calore, Ustioni da calore |
| English | Thermal Burn, Thermal burns, thermal burn, thermal burns, THERMAL BURN, BURN, THERMAL, BURNS, THERMAL, Thermal burn, Thermal burn (disorder), Thermal burn (morphologic abnormality), Thermal burn - disorder |
| Japanese | 熱傷, ﾈｯｼｮｳ |
| Czech | Tepelné popáleniny, Tepelná popálenina |
| Hungarian | Hő okozta égés, Hő okozta égések |
| Spanish | quemadura por agentes térmicos (anomalía morfológica), quemadura por agentes térmicos, quemadura térmica (trastorno), quemadura térmica, Quemadura térmica, Quemaduras térmicas |
| Portuguese | Queimadura térmica, Queimaduras térmicas |
| Dutch | brandwonden, thermische verbranding |
| French | Brûlure thermique, Brûlures thermiques |
| German | Thermalverbrennung, Verbrennungen durch Hitze |
