The Wallace rule of nines is a tool used in pre-hospital and emergency medicine to estimate the total body surface area (BSA) affected by a burn. In addition to determining burn severity, the measurement of burn surface area is important for estimating patients' fluid requirements and determining hospital admission criteria.[1]
Burn severity is determined through, among other things, the size of the skin affected. The image shows the makeup of different body parts, to help assess burn size.
The rule of nines was devised by Pulaski and Tennison in 1947, and published by Alexander Burns Wallace in 1951.[2]
To estimate the body surface area of a burn, the rule of nines assigns BSA values to each major body part:[3]
This allows the emergency medical provider to obtain a quick estimate of how much body surface area is burned. For example, if a patient's entire back (18%) and entire left leg (18%) are burned, about 36% of the patient's BSA is affected. The BSAs assigned to each body part refer to the entire body part.[4] So, for example, if half of a patient's left leg were burned, it would be assigned a BSA value of 9% (half the total surface area of the leg). Thus, if a patient's entire back (18%), but only half of their left leg (9%) was burned, the amount of BSA affected would be 27%.
^Livingston, M.D., Edward H.; Lee, B.S., Scott (2000). "Percentage of Burned Body Surface Area Determination in Obese and Nonobese Patients". Journal of Surgical Research. 91 (2): 106–110. doi:10.1006/jsre.2000.5909. PMID 10839957.
^Wallace, A. B. (1951-03-03). "The Exposure Treatment of Burns". The Lancet. Originally published as Volume 1, Issue 6653. 257 (6653): 501–504. doi:10.1016/S0140-6736(51)91975-7. ISSN 0140-6736. PMID 14805109.
^Hettiaratchy, S. Papini, R (July 2004). "ABC of burns: Initial management of a major burn: II—assessment and resuscitation". BMJ. 329 (7457): 101–103. doi:10.1136/bmj.329.7457.101. PMC 449823. PMID 15242917.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^"Emergency Medicine". UW Health. University of Washington School of Medicine and Public Health. Retrieved January 20, 2016.
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