I: Understanding the Diagnosis and Pathophysiology
1) Describe how burn wounds are classified. Identify and describe Mr. Angelo’s burn injuries.
Burn wounds are classified in three ways: by cause or etiology, by depth,
...
I: Understanding the Diagnosis and Pathophysiology
1) Describe how burn wounds are classified. Identify and describe Mr. Angelo’s burn injuries.
Burn wounds are classified in three ways: by cause or etiology, by depth, and by size or extent.1
According to the Nutrition Care Manual, the causal or etiological classifications for burn wounds are flame,
scald, contact, electrical, or chemical burns.1 Depth classification is determined by how deep the burn has
penetrated the skin. Table 1 (below) summarizes the criteria for measuring and classifying the depth of burn
wounds. Classification by extent refers to how much of the total body surface area (TBSA) is covered by burn
wounds. The size or extent of burn injuries is often estimated using the “rule of nines” explained in Question 2
below. Erythema should not be counted when calculating burn size.2 Burns covering more than 10% of a
patient’s TBSA should be referred to a burn center that provides specialized treatment, including nutrition
care.1
Mr. Angelo has thermal flame burns of various degrees covering approximately 40% of his body. He
has burns on his entire face as well as singed eyebrows, hair, and facial hair. There are first degree burns near
his umbilicus and second degree burns over his mid, left, and lower back; buttocks; abdomen; and bilateral
upper extremities. He has also had blistering over his scrotum and the head of his penis, which is indicative of
second degree burns.3 There are third degree burns circumferentially on his bilateral lower extremities.
Table 1
Classification of burn wounds by deptha
DEPTH OF BURN SKIN THICKNESS TISSUE LAYER
1 0.010” Epidermis
2 0.020” Dermis
3 0.035” Subcutaneous Tissue
4 0.040” Muscle
a Adapted from reference 3.
2) Explain the “rule of nines” used in assessment of burn injury.
The “rule of nines” is a common method for classifying burn injuries by size or extent. It allows medical
professionals to quickly estimate the percentage of a patient’s body that has been burned by dividing the body
into sections that each represent approximately 9% of the patient’s TBSA, then totaling the percentages from
the burned sections.2 Table 2 (below) summarizes the major body sections that are evaluated when applying
the “rule of nines”.4 These percentages are not applicable for children because their heads are proportionally
larger and their legs are proportionately smaller than those of adults.2,4
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