What is the Rule of Nines?

The Rule of Nines divides the adult body into regions each worth 9 percent of total body surface area or a multiple of nine: the head and each arm are 9 percent, the front and back of the trunk are 18 percent each, each leg is 18 percent, and the genitalia are 1 percent, totalling 100 percent.

Why use Lund-Browder for children?

Children have proportionally larger heads and smaller legs than adults, so the Rule of Nines overestimates leg burns and underestimates head burns in the young. The Lund-Browder chart adjusts the head and leg percentages by age band, making it the most accurate method, especially for infants and small children.

How does TBSA feed into the Parkland formula?

The Parkland formula estimates the first 24-hour fluid requirement as 4 mL multiplied by body weight in kilograms multiplied by percent TBSA burned. Half is given in the first 8 hours from the time of injury and the remaining half over the next 16 hours, then titrated to urine output.

Should I count superficial sunburn-type redness?

No. Only partial-thickness (second-degree) and full-thickness (third-degree) burns are counted towards TBSA. Superficial epidermal burns with erythema but no blistering, such as simple sunburn, are excluded because they do not drive significant fluid loss.

Is the palm method an alternative for small burns?

Yes. For small or patchy burns, the patient's own palm including fingers represents roughly 1 percent of their TBSA. That estimate is handy at the bedside, but for larger burns the Rule of Nines or Lund-Browder used here is more reliable.

TBSA Burn Calculator (Rule of Nines & Lund-Browder)

Estimating burn size for resuscitation

The single most important number in early burn care is percent total body surface area burned — it drives fluid resuscitation, transfer decisions and prognosis. This tool calculates TBSA two ways: the quick Rule of Nines for adults and the more precise, age-adjusted Lund-Browder chart for children, then feeds the result straight into the Parkland formula.

How it works

Each method assigns a maximum percentage to every body region. You enter how much of each region is burned (0–100%), and the tool sums the weighted contributions:

region contribution = region_max × (fraction burned)
TBSA = sum of all region contributions

In the Rule of Nines the maxima are fixed (head 9, each arm 9, each trunk surface 18, each leg 18, perineum 1). In Lund-Browder the head and leg percentages shrink and grow with age — an infant’s head is 19% versus an adult’s 7% — while the trunk, arms and hands stay constant.

The Parkland estimate then uses TBSA and weight:

first 24 h = 4 mL × weight_kg × %TBSA   (lactated Ringer's)
first 8 h  = half of that total
next 16 h  = the other half

Notes and example

A 70 kg adult with a fully burned anterior trunk (18%) and one whole arm (9%) has 27% TBSA, giving a Parkland estimate of about 7,560 mL in the first 24 hours — roughly 470 mL/hr for the first 8 hours.

Count only second- and third-degree burns, start the resuscitation clock at the time of injury (not arrival), and titrate to a urine output of 0.5–1 mL/kg/hr rather than running the formula rate blindly. The formula is a starting point, not a fixed prescription.