Injury Severity

🤔 Question: If a patient loses a limb in the process would that affect the TBSA at discharge since now he/ she has a body part that is missing? For example, if the patient comes with a 2.5% burn on the right hand and that hand gets amputated, at discharge that hand would be missing, therefore that burn area is not present anymore. Would the L&B still reflect that initial 2.5% TBSA?

🌱 Answer: Yes, in the case of a lost limb, the Lund & Browder would still be 2.5% 3rd degree to the Right hand. That area was burned and should be included even if amputated. 

🤔 Question: What is the correct way to fill out a Lund and Browder (L&B) chart at discharge. Is the percentage that IS NOT closed used or is the original TBSA used? For example, someone that came in with over 60% TBSA, but through the course of his admission was 90% closed. When the patient passed he only had 10% of open area. So is the amount of open area at discharge (10%) recorded?

🌱 Answer: "The Initial and Final L&B burn diagrams are both based on the total TBSA burn injury that the patient sustained.  The initial is used to calculate fluid resuscitation amounts and the exact areas that are second or third degree are not yet known at this time, as the burn wound is likely still progressing, thought the total TBSA burned is likely known.  The final burn diagram is the total TBSA burned with the exact amounts that are second and third degree calculated based on the what areas required grafting and which healed on their own.  If the patient dies before any or all grafting is done, the physician is the best source of how much of the burn was second and third degree.  See pages 69-70 in 2023 Data Dictionary. This is also going to be clarified in the 2024 Data Dictionary.

The final burn diagram has nothing to do with how much has healed or was grafted and how much remains open at the time of discharge.  That is recorded in a separate data field under outcomes. See: Percent Wound Closure at Time of Discharge on page 105. In the case of your patient with a 60% TBSA and 10% was still open at the time of discharge/death, you would fill in 90% was the Percentage of Wound Closure."

Total Burn Size 2nd Degree

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🌱 Answer: If this burn diagram represents accurately the initial TBSA, then yes it can be used. A final (ultimate) burn diagram, with the accurate total TBSA of what was second and what was third degree should also be completed.

Carboxyhemoglobin Level

🤔 Question: Should a carboxyhemoglobin level be drawn if there is not an inhalation injury?  Is there a time frame that a carboxyhemoglobin level should be taken? 

🌱 Answer: If a carboxyhemoglobin level was taken, you should document it. Many times, they may draw one to rule out that there was or was not an inhalation injury. Carboxyhemoglobin levels should be taken as soon as possible to guide care, especially if concerned with inhalation injury. Related to the Registry documentation, you should enter the first level taken.