Encyclopedia of Intensive Care Medicine

2012 Edition
| Editors: Jean-Louis Vincent, Jesse B. Hall

Burn Injury, Rule of Nines

Reference work entry
DOI: https://doi.org/10.1007/978-3-642-00418-6_380



Burn injuries represent a severe insult to body homeostasis. An extensive hypermetabolic and inflammatory response occurs as a consequence of thermal tissue damage to more than 40% of the total body surface area (TBSA) and can lead to considerable morbidity and mortality [1]. This response may be so extensive that victims invariably suffer cardiovascular derangements if more than one third of the TBSA is affected. This condition is defined as burn shock [2].


Quantifying the extent of the burn injury is of utmost importance because it allows the physician to provide an adequate and comprehensive treatment that includes fluid resuscitation, nutritional support, pharmacologic agents, wound care, surgical interventions, and rehabilitation.

The current understanding of how the burn size is associated to the inflammatory response and fluid shifts can be dated back to the studies performed by Frank P....

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  1. 1.
    Jeschke MG, Mlcak RP, Finnerty CC, Norbury WB, Gauglitz GG, Kulp GA, Herndon DN (2007) Burn size determines the inflammatory and hypermetabolic response. Crit Care 11(4):R90PubMedCrossRefGoogle Scholar
  2. 2.
    Herndon DN (2007) Total burn care, 3rd edn. Elsevier, Philadelphia, PA, p 93Google Scholar
  3. 3.
    Underhill FP (1930) The significance of anhydremia in extensive surface burns. JAMA 95:852CrossRefGoogle Scholar
  4. 4.
    Knaysi GA, Crikelair GF, Cosman B (1967) The rule of nines: it’s history and accuracy. Presentation at the Am Soc Plast & Reconstruct, New York City, November 6, 1967Google Scholar
  5. 5.
    Blocker TG Jr (October 1, 1981) Lecture given to plastic surgery residents. Galveston, TX (unpublished)Google Scholar
  6. 6.
    Moore FD (1970) The body-weight burn budget. Basic fluid therapy for the early burn. Surg Clin North Am 50(6):1249–1265PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Texas Medical Branch and Shriners Hospital for ChildrenGalvestonUSA
  2. 2.Department of Surgery, Division of Plastic SurgeryUniversity of Toronto, Sunnybrook Research InstituteTorontoCanada