Rule of Nines Burn Calculator (TBSA)
Total body surface area burned by the Wallace rule of nines for adults and the paediatric (Lund-Browder) adjustment — with Parkland fluid resuscitation volume and burn-centre referral criteria.
How it works
Adult: head 9, each arm 9, anterior trunk 18, posterior trunk 18, each leg 18, perineum 1 (= 100%). Infant: head 18, each leg 13.5. Parkland = 4 mL × kg × %TBSA over 24 h, half in the first 8 h
Wallace’s rule of nines divides the adult body into regions of roughly 9% (or multiples) of surface area so that a burn can be sized quickly in the resuscitation room. Only partial- and full-thickness burns count; superficial erythema does not. Children have proportionally larger heads and smaller legs, so the infant values shift (head 18%, legs 13.5%) and the Lund-Browder chart gives age-specific figures for children in between. The percentage drives everything that follows: fluid resuscitation by the Parkland formula once burns exceed 15% in adults or 10% in children, transfer to a burn centre, and prognosis. Estimates by rule of nines tend to over-estimate small burns and in obese patients, so re-measure formally with a Lund-Browder chart once the patient is stable.
Worked example
An adult with the whole anterior trunk (18%), the whole left arm (9%) and half of the left leg (9%) burned: 36% TBSA — major burn. At 75 kg the Parkland volume is 10,800 mL: 5,400 mL in the first 8 hours (675 mL/h), then 5,400 mL over 16 hours.
Frequently asked questions
When does the first 8 hours start?
From the time of injury, not arrival — if the patient presents two hours after the burn, the first half must be given over the remaining six hours.
Is Parkland a fixed prescription?
No — it is a starting rate. Titrate to urine output of 0.5 mL/kg/h in adults (1 mL/kg/h in children); many centres now use the modified Brooke formula (2 mL/kg/%) to avoid over-resuscitation.
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Clinical decision tool for education and for use by trained clinicians alongside judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.