A 35 years old female was brought to the Emergency department with burn injury over the abdomen, perineum and both thighs. According to Rule of Nines, what is the percentage of burn injury for this patient?

1. A

   18%

2. B

   19%

3. C

   28%

4. D

   38%

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• The Rule of Nines is a tool used to estimate the total body surface area (TBSA) affected by burns in adults.
• According to this rule, the abdomen accounts for 9% of TBSA.
• The perineum accounts for 1% of TBSA.
• Each thigh (upper leg) represents 9% of TBSA, so both thighs together account for 18%.
• The total burn percentage is calculated by summing the individual areas: 9% (abdomen) + 1% (perineum) + 18% (both thighs) = 28%.

Why Other Options Were Wrong

• Option A: This value incorrectly only accounts for the burn on both thighs (9% + 9%), omitting the 9% for the abdomen and 1% for the perineum.
• Option B: This value is a miscalculation. It might be derived from adding the entire anterior trunk (18%) and the perineum (1%), but this does not match the patient's specific injuries.
• Option D: This is a significant overestimation. It likely results from a calculation error, such as incorrectly adding the entire anterior trunk (18%) to both thighs (18%) and the perineum (1%), which would total 37%.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Calculation of Total Body Surface Area (TBSA) of burn using the Rule of Nines in acute care settings.
• Accurate TBSA estimation is a critical first step in burn management as it directly influences the calculation for fluid resuscitation, most commonly using the Parkland formula (4 mL of fluid × body weight in kg × %TBSA).
• Underestimation of TBSA can lead to inadequate fluid replacement, causing hypovolemic shock and organ failure. Overestimation can lead to fluid overload, resulting in complications like pulmonary edema and compartment syndrome.
• What if the patient was a 3-year-old child? The Rule of Nines would be inaccurate. The Lund-Browder chart must be used, as it accounts for a child's proportionally larger head and smaller legs, ensuring more precise fluid resuscitation.

How to Approach the Question

• First, identify the patient's age (35 years) to confirm that the adult Rule of Nines is the appropriate tool for assessment.
• Next, list all the burned body parts mentioned in the clinical scenario: abdomen, perineum, and both thighs.
• Recall the standard percentage for each part according to the adult Rule of Nines: Abdomen = 9%, Perineum = 1%, and each thigh = 9%.
• Sum the percentages for all affected areas: 9% (abdomen) + 1% (perineum) + 9% (right thigh) + 9% (left thigh).
• Calculate the total: 9 + 1 + 18 = 28%.
• Finally, match your calculated total with the given options to select the correct answer.

Concept Tested & Keywords

• Concept Tested: Calculation of Total Body Surface Area (TBSA) of burn using the Rule of Nines.
• Stem keywords: burn injury, Rule of Nines, abdomen, perineum, both thighs
• Lead-in keywords: what is the percentage
• Clinical cues: 35 years old female (indicates adult rule applies)
• Negative lead-in flag: false

Question ID

QEyK7HpgZVpxCUhSLJ67Hs

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 693-695

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 747-749