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Burn Classification
Medical Reference Burn Classification

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Rachel Warby

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Christopher Maani

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9/5/2021 12:57:27 AM

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Burn Classification

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Definition/Introduction
A burn takes place when the skin comes into contact with a heat source.[1] Burns can occur from many different sources. The most common
sources that cause burns are fire/flame, scalds, hot objects, electrical, and chemical agents, respectively.[2] Injuries related to a burn are highly
variable, as is their severity. Morbidity and mortality tend to increase as the surface area of the burn increases.[3] It is vital to classify a burn
accurately, as it can help determine the outcome, as well as guide initial management.[2] The skin location, the degree of temperature, and
duration are contributing factors to the severity of the burn. There is a synergistic effect between the temperature and duration of exposure.[4]
Skin exposure to 140 degrees Fahrenheit (60 degrees Celsius) for 10 seconds can cause a full-thickness burn.[1]

Issues of Concern
The basis of burn classification is depth. When examining a burn, there are four components needed to assess depth: appearance, blanching to
pressure, pain, and sensation.[2] Burns can be categorized by thickness according to the American Burn Criteria using those four elements. Burn
injuries tend to be a dynamic process. Some burns, especially partial-thickness, may progress over 2 to 4 days, peaking at day 3.[4]

Partial Thickness

Superficial (first-degree) involves the epidermis of the skin only. It appears pink to red, there are no blisters, and it is dry. It is moderately painful.
Superficial burns heal without scarring within 5 to 10 days.[1][4]

Superficial partial-thickness (second-degree) involves the superficial dermis. It appears red with blisters and is wet. The erythema blanches with
pressure. The pain associated with superficial partial-thickness is severe. Healing typically occurs within 3 weeks with minimal scarring.[1][4]

Deep partial-thickness (second-degree) involves the deeper dermis. It appears yellow or white, is dry, and does not blanch with pressure. There
is minimal pain due to a decreased sensation. Healing occurs in 3 to 8 weeks with scarring present.[1][4]

Full Thickness

Third-degree involves the full thickness of skin and subcutaneous structures. It appears white or black/brown. With pressure, no blanching
occurs. The burn is leathery and dry. There is minimal to no pain because of decreased sensation. Full-thickness burns heal by contracture and
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take greater than 8 weeks. Full-thickness burns require skin grafting.[1][4]

Fourth degree shows charred skin with possible exposed bone.

Fifth degree has charred, white skin, and exposed bone.

Sixth degree has loss of skin with exposed bone.

Clinical Significance
Burns are a common injury seen in emergency departments around the world.[3] Even as emergency management improves, burns continue to
have significant morbidity and mortality. Burn treatments, such as intravenous fluids and surgical options, are based upon the classification of
the burn. It is essential to accurately classify burns to optimize treatment and provide an accurate prognosis.[5][6]

References

[1] Tolles J, Emergency department management of patients with thermal burns. Emergency medicine
practice. 2018 Feb; [PubMed PMID: 29369586]

[2] Toussaint J,Singer AJ, The evaluation and management of thermal injuries: 2014 update. Clinical and
experimental emergency medicine. 2014 Sep; [PubMed PMID: 27752547]

[3] Vivó C,Galeiras R,del Caz MD, Initial evaluation and management of the critical burn patient.
Medicina intensiva. 2016 Jan-Feb; [PubMed PMID: 26724246]

[4] Evers LH,Bhavsar D,Mailänder P, The biology of burn injury. Experimental dermatology. 2010 Sep;
[PubMed PMID: 20629737]

[5] Hautier A, [Minor burn outpatient management]. La Revue du praticien. 2018 Dec [PubMed PMID:
30869212]

[6] Nicolas C,Maréchal O, [Severe burned patient rehabilitation]. La Revue du praticien. 2018 Dec
[PubMed PMID: 30869214]

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