The 'Rule of Nines' and Lund-Browder chart are used to estimate body surface area (BSA) burned. In a 5-year-old child with burns, why does the Lund-Browder chart give a more accurate BSA estimate compared to the Rule of Nines?

• A The Lund-Browder chart includes chemical burn depth assessment
• B The Rule of Nines overestimates the palm area in children
• C The Lund-Browder chart accounts for inhalation injury contributions to BSA
• D Children have a proportionally larger head (18% vs 9%) and smaller lower limbs compared to adults; the Lund-Browder chart adjusts for age-related surface area proportions ✓

Explanation

The Rule of Nines assigns 9% to the head and 18% to each lower limb in adults, but children have proportionally larger heads and smaller lower limbs relative to total BSA. In a newborn, the head accounts for ~18% and each lower limb ~14%; proportions gradually shift to adult values by late adolescence. The Lund-Browder chart adjusts for age by providing specific percentages for head, thigh, and lower leg at ages 1, 5, 10, and 15 years, providing substantially more accurate BSA estimates in children and therefore more accurate fluid resuscitation volumes using the Parkland formula (4 mL/kg/% BSA burned).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.