Burns 32 (2006) 134

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Letter to the Editor

Assessment of burn area: Can we be more objective?

We currently estimate burn area subjectively using the

Lund Browder charts. Although this is an easy and widely
accepted method worldwide, it has certain disadvantages.
Most importantly there is poor inter-rater reliability
especially with increase in burn size and irregularity in
shape of the burn [1]. The burn estimations are not
accurate in people with high BMI [2] and in breast burns
[3]. Recently, 3D computer programmes such as the 3D
Burn Vision have been used although these too involve
subjective observation [4]. I propose digital anthropome-
try for objective assessment of burn area. The idea is
common to military and geological survey aircraft that use
Fig. 1. Measuring area of an object from a distance using a camera.
a camera to estimate ground surface area from a height.
The basic idea is explained in Fig. 1. Therefore, given that References
we know the focal length of the lens and the distance to
the burn we can quantify the burn area in terms of cm2. I [1] Wachtel TL, Berry CC, Wachtel EE, Frank HA. The inter-rater relia-
used a thermal camera TH7102MV/MX, NEC San-ei bility of estimating the size of burns from various burn area chart
Instruments Limited (Provided by Metrum Information drawings. Burns 2000;26(2):156–70.
Storage Limited, UK) to estimate area of an object at a [2] Berry MG, Evison D, Roberts AH. The influence of body mass index on
burn surface area estimated from the area of the hand. Burns
distance. The only difficulty at present is to accurately 2001;27(6):591–4.
estimate the distance to the object (burn in this case) in [3] Hidvegi N, Nduka C, Myers S, Dziewulski P. Estimation of breast burn
real time and to incorporate this information in the size. Plastic Reconstruct Surg 2004;11(6):1591–7.
software. This concept should be taken forward as it will [4] Neuwalder JM, Sampson C, Breuing KH, Orgill DP. BURNWARE:
make the assessment of burn area more accurate and NATIONAL-TRACS/ABA computer use in the burns center. A review
of computer-aided body surface area determination: SAGE II and
objective. EPRI’s 3D Burn Vision . . . including commentary by Miller SF and
The distance from D to E and A to B are proportional to McDonald Smith GP. J Burn Care Rehab 2002;23(1):55–9.
the ratio of the focal length ( f) to the height above the
ground (H). This allows for the calculation of proportional S. Kalra*
lengths because the angles formed on either side of the Royal Orthopaedic Hospital, Room-142 Nurses Home,
lens, labeled point C on the diagram, are identical. Also Bristol Road South, Birmigham B31 2AP, UK
note that the center point of the image (the Principal Point,
PP) and the actual center point on the ground (Nadir) fall *Tel.: +44 7984339626
along the optical axis of the camera in this idealized E-mail address: mehak07@yahoo.co.uk
diagram

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doi:10.1016/j.burns.2005.08.024