55 Designing and Implementing an Obese Lund and Browder: A Pilot Study

Abstract

\n \n \n Accurate determination of the total body surface area (TBSA) burned is an essential element for the clinical management of burn care. The Lund and Browder (LB) is a tool that allows practitioners to calculate the TBSA burned, which is used to determine fluid needs, nutritional requirements, and graft site availability. Studies have shown that individuals with a body mass index (BMI) greater than 30 have an increase in surface area in the trunk and lower extremities, making the applicability of the traditional LB less accurate. The objective of this study was to develop and implement an electronic obese LB and compare it to the traditional LB.\n \n \n \n Using the paper by Williams et al. as a guide, an obese LB was constructed for each body type: android, gynecoid and mixed (Table 1). Based on the patients BMI, the hospital’s Electronic Medical Record (EMR) would direct staff to the appropriate LB. All providers were formally trained on the obese LB, body types and changes in body surface area measurements. A retrospective chart review of adult patients admitted from January 2020 to September 2020 with a BMI≥30 was conducted. The BMI, body type, and location of burn was analyzed for each patient. The TBSA burned was recalculated for each patient using the traditional LB and compared to the obese LB completed at admission.\n \n \n \n A total of nineteen patients had a BMI≥30 and an admission obese LB completed. The TBSA burned ranged from 0.25–78.5%. The difference in TBSA burned calculated by the traditional and obese LB was 4.2±8.8 % (Figure 1). In patients with burns to the trunk or lower extremities (n=7) a difference of 12±10.5% was observed.\n \n \n \n Limited research exists demonstrating the use of a standardized obese LB in clinical practice. No patient complications were identified with the use of the developed obese LB. Evaluation of the data revealed that the traditional LB often underestimated the TBSA burned in obese patients with burns to the trunk and/or lower extremities. This could lead to under-resuscitation and complications related to hypovolemia. In addition, expectations on patient survival and outcomes become inaccurate. As obesity grows in prevalence having a LB that recognizes the difference in surface area observed in the trunk and lower extremities can improve patient outcomes. Further research with a larger sample size is needed to gain a greater understanding of the clinical impact of an obese LB. We have shown that accurate determination of the burn area in obese patients can be done in a standardized fashion within the EMR.\n \n \n