Intended for healthcare professionals

Practice Clinical updates

Managing a small burn

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2021-068812 (Published 21 October 2022) Cite this as: BMJ 2022;379:e068812
  1. John Henry George Antrum, specialist registrar in plastic surgery1,
  2. Jennifer Eleanor Galloway, specialist registrar in emergency medicine2,
  3. Mohammad Umair Anwar, consultant burns and plastic surgeon1,
  4. Sophie Louise Hodson, foundation doctor3
  1. 1Pinderfields General Hospital Wakefield, Wakefield, UK
  2. 2Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  3. 3Hull Royal Infirmary Hull, Kingston upon Hull, UK
  1. Correspondence to: J H G Antrum henry.antrum{at}nhs.net

What you need to know

  • When calculating burn size, 1% of total body surface area (TBSA) is roughly equal to the size of the patient’s hand, including digits

  • Do not include areas of erythema without skin loss when calculating burn size

  • Small burns <2% TBSA in children and <3% TBSA in adults can be managed in local accident and emergency departments, minor injuries centres, or primary care practices if the patient is clinically stable and there are no complications or associated injuries

  • Cooling of the burn is effective up to 3 hours after the injury

  • Flamazine (silver sulphadiazine) cream is avoided except for infected burns as it is absorbed by the burnt skin and makes depth estimation difficult. It can also delay healing

Burn injuries are a common cause of presentation to hospitals and urgent care centres globally.1 About 137 000 patients attended accident and emergency (A&E) departments in England with a burn or a scald in 2019.2 Approximately 64 000 children seek medical attention for a burn from hospital or primary care centres in the UK each year.3 In the United States, 486 000 patients received medical treatment for burn wounds, which constituted approximately 2% of all emergency department attendances in 2017.4

Most burns can be managed in an outpatient setting with attentive wound care and regular changes of dressings. Inaccurate estimation of the burn size can result in inappropriate referrals to burns centres. Mismanagement of the wound increases the potential for prolonged pain,5 delayed healing, infection,6 and excessive scarring.7

This clinical update consolidates recent guidelines to help clinicians working in primary and urgent care facilities with assessment and management of small burn wounds. The management of burns from chemical and electrical injuries is not covered in this article.

What is a small burn?

There is no clear definition for a small or a large …

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