🔥 Burn Surface Area (Rule of Nines)
Estimate adult burn surface area (%TBSA) with the Wallace rule of nines.
Clinical takeaway
≥ 15–20% TBSA needs formal fluid resuscitation (Parkland).
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When to use
Guide burn fluid resuscitation and burn-center referral.
How it works
Head/neck 9, each arm 9, anterior/posterior trunk 18 each, each leg 18, perineum 1 (100% total). Count second-degree and deeper only.
Key points
- ≥ 15–20% TBSA needs formal fluid resuscitation (Parkland).
- Palm (incl. fingers) ≈ 1% TBSA for small burns.
- Use the Lund-Browder chart in children.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Head & neck (max 9%) | None (0) |
|---|---|
| Right arm (max 9%) | None (0) |
| Left arm (max 9%) | None (0) |
| Anterior trunk (max 18%) | None (0) |
| Posterior trunk (max 18%) | None (0) |
| Right leg (max 18%) | None (0) |
| Left leg (max 18%) | None (0) |
| Perineum (max 1%) | None (0) |
→Total burn surface area0 % TBSA
- Area：0% (Smaller area). Count second-degree and deeper only
- Resuscitation：≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 0 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h
- Small/scattered：Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA
| Head & neck (max 9%) | All (9) |
|---|---|
| Right arm (max 9%) | All (9) |
| Left arm (max 9%) | All (9) |
| Anterior trunk (max 18%) | All (18) |
| Posterior trunk (max 18%) | All (18) |
| Right leg (max 18%) | All (18) |
| Left leg (max 18%) | All (18) |
| Perineum (max 1%) | Involved (1) |
→Total burn surface area100 % TBSA
- Area：100% (Large area (aggressive fluid resuscitation)). Count second-degree and deeper only
- Resuscitation：≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 400 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h
- Small/scattered：Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA
Frequently asked questions
- What is Burn Surface Area (Rule of Nines)?
- Estimate adult burn surface area (%TBSA) with the Wallace rule of nines.
- How is Burn Surface Area (Rule of Nines) calculated? What is the core formula?
- Head/neck 9, each arm 9, anterior/posterior trunk 18 each, each leg 18, perineum 1 (100% total). Count second-degree and deeper only.
- When is Burn Surface Area (Rule of Nines) used?
- Guide burn fluid resuscitation and burn-center referral.
- What are the key clinical points for Burn Surface Area (Rule of Nines)?
- ≥ 15–20% TBSA needs formal fluid resuscitation (Parkland). Palm (incl. fingers) ≈ 1% TBSA for small burns. Use the Lund-Browder chart in children.
- What are the limits and cautions when using Burn Surface Area (Rule of Nines)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Burn Surface Area (Rule of Nines) calculated in practice? Can you show a worked example?
- Inputs: Head & neck (max 9%) None (0), Right arm (max 9%) None (0), Left arm (max 9%) None (0), Anterior trunk (max 18%) None (0), Posterior trunk (max 18%) None (0), Right leg (max 18%) None (0), Left leg (max 18%) None (0), Perineum (max 1%) None (0) → Result: Total burn surface area 0 % TBSA（Area: 0% (Smaller area). Count second-degree and deeper only, Resuscitation: ≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 0 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h, Small/scattered: Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA） Inputs: Head & neck (max 9%) All (9), Right arm (max 9%) All (9), Left arm (max 9%) All (9), Anterior trunk (max 18%) All (18), Posterior trunk (max 18%) All (18), Right leg (max 18%) All (18), Left leg (max 18%) All (18), Perineum (max 1%) Involved (1) → Result: Total burn surface area 100 % TBSA（Area: 100% (Large area (aggressive fluid resuscitation)). Count second-degree and deeper only, Resuscitation: ≥ 15–20% TBSA needs formal fluid resuscitation. Parkland: 24 h lactated Ringer's = 4 mL × weight (kg) × %TBSA = 400 mL/kg body weight, half in the first 8 h (from time of injury), titrated to urine output 0.5–1 mL/kg/h, Small/scattered: Palm method: the patient's palm (incl. fingers) ≈ 1% TBSA）