Burn classification
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Burn classification On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Classification
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]
- First-degree burns(Partial Thickness Superficial) are usually limited to redness (erythema), a white plaque and minor pain at the site of injury. These burns only involve the epidermis of the skin.[4]
- Second-degree burns(Superficial partial-thickness) manifest as erythema with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. Second-degree burns involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.
- Third-degree burns occur when most of the epidermis is lost with damage to underlying ligaments, tendons and muscle. Burn victims will exhibit charring of the skin, and sometimes hard eschars will be present. An eschar is a scab that has separated from the unaffected part of the body. These types of burns are often considered painless, because nerve endings have been destroyed in the burned area. Hair follicles and sweat glands may also be lost due to complete destruction of the dermis. Third degree burns result in scarring and may be fatal if the affected area is significantly large. If extensive enough, it can increase the risk of infection, including bacterial, and can result in death.
- Fourth-degree burns damage bone tissue and may result in a condition called compartment syndrome, which threatens both the life of the limb and the patient.
- Fifth-degree burns are burns in which most of the hypodermis is lost, charring and exposing the muscle underneath. Sometimes, fifth-degree burns can be fatal.
- Sixth-degree burns, the most severe form, are burn types in which almost all the muscle tissue in the area is destroyed, leaving almost nothing but charred bone. Often, sixth-degree burns are fatal.
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.
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.
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References
- ↑ Burn Degrees Lifespan.com Accessed February 24, 2008
- ↑ 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
- ↑ 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
- ↑ Tolles J (2018) Emergency department management of patients with thermal burns. Emerg Med Pract 20 (2):1-24. PMID: 29369586 PMID: 29369586