Updated Burn Scale

It’s crazy how fast medicine changes! It first hits you when your preceptor references some archaic medical skill you’ve never heard of or when you get word some legendary older attending retired because they weren’t efficient using a computer (seriously, it’s quite common). But then it starts getting weird. Some fresh out of residency attending attempts to give you studying advice only to give them a strange stare since that book/website no longer exists. Then the wheels fell off the train when my attending asked me last week “how do you classify burns?” and I was like I got this! “You use a grading criteria from 1st to 4th degree.” Boom, toasted. Only for him to respond plainly, “Nope. It’s now a verbal scale.” How am I now outdated!? Me, who’s still in school no longer has the most current information. Just goes to show you how quickly medicine evolves and how it’s up to us to stay relevant. Good luck.

Content from Classification of burns on UpToDate

Here is my simplified breakdown on the 5 criteria’s:

  • Superficial – (previously 1st degree) involves only the epidermis. red & blanches. blisteringexample: sunburn. heals in ~1 week.
  • Superficial Partial-thickness – (previously 2nd degree) may appear initially as superficial only but BLISTERS & WEEPS. most painful. heals in ~3 weeks.
  • Deep Partial-thickness – (previously 2nd degree too) yellow/white. hair follicles & NERVE DAMAGED, patient only senses pressure. scarring. ~8 months recovery.
    • fig1.jpg
  • Full-thickness – (previously 3rd degree) all dermal layers destroyed. ESCHAR/leathery. painless. scarring with potential amputation.
    • 40239.jpg
  • Fourth degree – FASCIA, MUSCLE, BONE involved. black. amputation mandatory. potentially life threatening.
    • Verbrennung_4grad_elek01.jpg

A couple concluding points: (1) Apparently the labeling transition from 1st/2nd/3rd degree burns to now thickness categories better reflects the patient’s surgical needs. And yes they kept 4th degree burns, that wasn’t a typo. (2) Burn severity appears to be inversely related to color for the first 3 categories with worse burns containing lighter colors. (superficial burn red –> deep partial-thickness burn yellow/white). While the worst burns (full-thickness & fourth degree) are black since the tissue chars like a wooden log. (3) Finally, classifying burns is difficult. Many times burns appear less severe initially then they actually are (electrical burns are notorious for this) so don’t be surprised if the burn’s severity is later upgraded. Hope this helps!

Image Credit: [1, 2, 3, 4]

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