ARCHETYPE Relative body surface area burnt (openEHR-EHR-CLUSTER.relative_body_surface_area_assessment-burn.v0)

Type: openEHR ARCHETYPE
Purpose: For recording percentage of total body area affected by burns.
Use: Use in 'Examination findings' slots of other archetypes, for example CLUSTER.exam, CLUSTER.exam-skin, CLUSTER.exam_burn and specialisations of those. These scales/rules ar often displayed to end users in tabular form with e.g. burn depth as columns and body parts/areas as rows. Systems should preferably not store anything (e.g. not store 0%) for body part sections and burn depth levels within them that are not injured.
Misuse: Do not use 'Comment' or extensions for detailed descriptions, cause and etiology of injuries and diseases; instead use suitable fields in archetypes like CLUSTER.exam, CLUSTER.exam-skin, CLUSTER.exam_burn or EVALUATION.problem_diagnosis that this surface area assessment is likely nested within when used in EHRs.

Available formats: ADL XML

ARCHETYPE IDopenEHR-EHR-CLUSTER.relative_body_surface_area_assessment-burn.v0
ConceptRelative body surface area burnt
DescriptionAssessment of relative body surface area affected by burns, estimated using methods like Lund-Browder chart, Wallace rule of nines, etc.
UseUse in 'Examination findings' slots of other archetypes, for example CLUSTER.exam, CLUSTER.exam-skin, CLUSTER.exam_burn and specialisations of those. These scales/rules ar often displayed to end users in tabular form with e.g. burn depth as columns and body parts/areas as rows. Systems should preferably not store anything (e.g. not store 0%) for body part sections and burn depth levels within them that are not injured.
MisuseDo not use 'Comment' or extensions for detailed descriptions, cause and etiology of injuries and diseases; instead use suitable fields in archetypes like CLUSTER.exam, CLUSTER.exam-skin, CLUSTER.exam_burn or EVALUATION.problem_diagnosis that this surface area assessment is likely nested within when used in EHRs.
PurposeFor recording percentage of total body area affected by burns.
ReferencesHettiaratchy S, Papini R. Initial management of a major burn: II--assessment and resuscitation. BMJ. 2004;329(7457):101-103. doi:10.1136/bmj.329.7457.101 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC449823/

Lund-Browder Charts
https://www.remm.nlm.gov/burns.htm & https://www.remm.nlm.gov/LundBrowder.pdf
https://www.rch.org.au/burns/clinical_information/#lund-and-browder-chart
https://en.wikipedia.org/wiki/Lund_and_Browder_chart

https://en.wikipedia.org/wiki/Total_body_surface_area

Rhodes J, Clay C, Phillips M. The surface area of the hand and the palm for estimating percentage of total body surface area: results of a meta-analysis. Br J Dermatol. 2013;169(1):76-84. doi:10.1111/bjd.12290

Scarisbrick JJ, Morris S. How big is your hand and should you use it to score skin in cutaneous T-cell lymphoma?. Br J Dermatol. 2013;169(2):260-265. doi:10.1111/bjd.12403 Available from: https://pubmed.ncbi.nlm.nih.gov/23621659/

https://www.vicburns.org.au/wp-content/uploads/2016/06/poster4-paediatric-burns-assessment-ruler.pdf
AuthorsAuthor name: Erik Sundvall
Organisation: Region Östergötland & Linköping University
Email: erik.sundvall@regionostergotland.se & erik.sundvall@liu.se
Date originally authored: 2020-07-30
Other Details LanguageAuthor name: Erik Sundvall
Organisation: Region Östergötland & Linköping University
Email: erik.sundvall@regionostergotland.se & erik.sundvall@liu.se
Date originally authored: 2020-07-30
Other Details (Language Independent)
  • Licence: This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.
  • Custodian Organisation: openEHR Foundation
  • References: Hettiaratchy S, Papini R. Initial management of a major burn: II--assessment and resuscitation. BMJ. 2004;329(7457):101-103. doi:10.1136/bmj.329.7457.101 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC449823/ Lund-Browder Charts https://www.remm.nlm.gov/burns.htm & https://www.remm.nlm.gov/LundBrowder.pdf https://www.rch.org.au/burns/clinical_information/#lund-and-browder-chart https://en.wikipedia.org/wiki/Lund_and_Browder_chart https://en.wikipedia.org/wiki/Total_body_surface_area Rhodes J, Clay C, Phillips M. The surface area of the hand and the palm for estimating percentage of total body surface area: results of a meta-analysis. Br J Dermatol. 2013;169(1):76-84. doi:10.1111/bjd.12290 Scarisbrick JJ, Morris S. How big is your hand and should you use it to score skin in cutaneous T-cell lymphoma?. Br J Dermatol. 2013;169(2):260-265. doi:10.1111/bjd.12403 Available from: https://pubmed.ncbi.nlm.nih.gov/23621659/ https://www.vicburns.org.au/wp-content/uploads/2016/06/poster4-paediatric-burns-assessment-ruler.pdf
  • Original Namespace: org.openehr
  • Original Publisher: openEHR Foundation
  • Custodian Namespace: org.openehr
  • MD5-CAM-1.0.1: 8C084F46711958ACC882C09FF6E9CD4F
  • Build Uid: f231cb22-296d-4cfe-9eda-c4ddab0cc393
  • Ip Acknowledgements: This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomedct or info@snomed.org.
  • Revision: 0.0.1-alpha
Keywordssurface area, burns, burn assessment, Lund-Browder, skin area, rule of nines, palmar method, TBSA, TBSA%
Lifecyclein_development
UIDfef2df95-cf31-4318-87d5-4210c1791da2
Language useden
Citeable Identifier520.41.2
Revision Number0.0.1-alpha
items
Estimation methodEstimation method:
  • Lund-Browder Chart [Chart of body parts' relateive area, using age category dependent values for head and legs]
  • Wallace Rule of nines [Divides body roughly into fractions of multiples of 9%, (Not accurate for children)]
  • Modified Rule of nines for pediatric use
  • Hand surface area (HSA) [Based on that the patient's hand (palm + fingers) is approximately 1% of total body surface area]
  • Palm surface area (PSA) [Based on that the patient's palm (fingers excluded) is approximately 0.5% of total body surface area]
  • Image analysis [Algorithm (software) based analysis of data obtained by imaging methods]
  • Rule of five [Used for obese patients etc. TODO: add reference/name]
Age interval or category usedAge interval or category used: Age category interval used for area estimation in the method, if any.
Choice of:
  •  Interval of Quantity
    Lower: Units: >=0.0 yr

    Upper: Units: yr
  •  Coded Text
    • 0-1 years [Scale for infants and children less than 1 year old]
    • 1-4 years [Scale for children 1-4 years old]
    • 5-9 years [Scale for children 5-9 years old]
    • 10-14 years [Scale for children 10-14 years old]
    • 15 years [Scale for adolescents approximately 15 years old]
    • Adult [Scale for adults]
    • 10-15 years [Scale for children 10-15 years old]
    • Child [Scale for children]
    • Adult, obese [Scale for obese aduts >80 kg]
CommentComment: Information about the estimation that could not captured in other fields.
Partial skin areaPartial skin area: To be repeated and configured in template, if the predefined body parts/areas in available templates or archetype specializations do not fit the use case.
Example: In some use cases upper arm and lower arm are recorded separately and in some other use cases recorded together as arm. Remember to remove (0..0) old overlapping parts if new ones are introduced, to avoid possibility of double registration.
Area nameArea name: Name of skin area, preferably coded with terminology like Snomed CT.
LateralityLaterality: Side of body, for skin regions involving arms, legs, buttocks etc.
Example: In some use cases buttocks (right and left) are added and recorded as one field and in other use cases they are recorded separately.
  • Left
  • Right
  • Bilateral (right and left)
Relative area (% of total body area)Relative area (% of total body area): The age-category-dependent relative area (percentage of full body area) that the estimation method (e.g. 'Lund-Browder chart' or 'rule of nines') assigns to this body part.
When 'Estimation Method' and 'Age category...' have been selected, this number could be automatically filled by the system. The 'Total burns on this part' for this partial area should never exceed this number. All the
  • Percent
Extension per areaExtension per area: Include:
All not explicitly excluded archetypes
Burns per depthBurns per depth: Repeat once for each depth category used in template.
DepthDepth: The burn depth category used for the estimation.
Some applications of e.g. the Lund-Browder chart only discern Partial v.s. Full thickness burns, but others use more granular levels like 'deep partial thickness burn' Corresponding codes are available in SNOMED CT
  • Epidermal burn [First degree burn, Superficial epidermal burn (For example sunburn) Not included in TBSA%]
  • Partial thickness burn [Second degree burn (old deprecated description)]
  • Superficial partial thickness burn [Superficial second degree burn, SPSL - Superficial partial skin loss burn]
  • Deep partial thickness burn [Deep second degree burn / Deep dermal burn]
  • Full thickness burn [Third degree burn]
  • Deep full thickness burn [Fourth degree burn]
Burnt area, precentage of full bodyBurnt area, precentage of full body:
  • Percent
Sum of burnt area on this partSum of burnt area on this part: Sum of the areas of different depth categories
Note that Epiderminal (first degree) burns are usually _not_ included in these partial sums (since they may be used for TBSA% calculation).
Sum of areas
TBSA%, total burnt body surface areaTBSA%, total burnt body surface area: Sum of affected/burnt area of whole body
Summing up all 'Sum of burnt area on this part' for all body parts should equal summing up all 'Total burnt area of this depth category' Note that Epiderminal (first degree) burns are usually _not_ included in the TBSA% calculation.
  • Percent
Sum extensionSum extension: Include:
All not explicitly excluded archetypes
Burns per depth category
DepthDepth: The burn depth category used for the estimation.
Some applications of e.g. the Lund-Browder chart only discern Partial v.s. Full thickness burns, but others use more granular levels like 'deep partial thickness burn' Corresponding codes are available in SNOMED CT
  • Epidermal burn [First degree burn, Superficial epidermal burn (For example sunburn) Not included in TBSA%]
  • Partial thickness burn [Second degree burn (old deprecated description)]
  • Superficial partial thickness burn [Superficial second degree burn, SPSL - Superficial partial skin loss burn]
  • Deep partial thickness burn [Deep second degree burn / Deep dermal burn]
  • Full thickness burn [Third degree burn]
  • Deep full thickness burn [Fourth degree burn]
Total burnt area of this depth categoryTotal burnt area of this depth category: Total burnt area of this depth category, precentage of full body
  • Percent
ExtensionExtension: Include:
All not explicitly excluded archetypes
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