the determination of total burn surface area
TRANSCRIPT
Letter to the Editor
Re: Should we give vitamin D tosevere burns patients? Theconundrum
To the Editor,
We would to thank Professor GL Klein for his informative
response to our letter, ‘‘Should we give vitamin D to severe
difference?’’ by Giretzlehner et al. [1]. The research analyzes
the variance and accuracy of common methods used for
estimation of total burn surface area on a regular basis versus
a computer-based surface estimation and documentation
method. The study shows that the participants used either of
the different methods used for determination of total burn
surface area routinely, i.e. ‘‘Rule of Palm’’, ‘‘Rule of Nines’’,
‘‘Lund–Browder Chart’’ or other methods. These methods
have shown exceptionally high deviations in contrast to a
computer-aided method in the study. The article hence, raises
a very pertinent issue relating to improving the objectivity and
b u r n s 4 0 ( 2 0 1 4 ) 1 6 4 – 1 7 4170
burns patients?’’ [1]. We were treating a patient with 40%
burns at the time of writing and the observation of a low
vitamin D level was made during a routine nutritional status
work up. We acknowledge that this result alone is not
sufficient to reliably inform us of a patient’s vitamin D level
and long-term measurement is required.
We are not aware of any study that has determined whether
severe burns patients have a higher risk of fractures in the adult
population. If we presume there is a risk then it would be
important to supplement burns patients’ diets with vitamin D.
However, as Klein points out in this letter, there is a disruption
in the normal hormonal and protein balance following burn
injury, then perhaps supplementation of the diet should start
later in a patient’s treatment rather than early. Klein also
suggests that there is a high likelihood that a severe burns
patient would be vitamin D deficient which raises the question
of ‘‘when’’ should we supplement rather than ‘‘if’’.
We feel that the question is an important one that warrants
further research and we are in the process of setting up
prospective trial to attempt to answer some of these questions.
r e f e r e n c e
[1] Mehta S, Booth S, Dheansa B. Should we give vitamin D tosevere burns patients? Burns 2013;39(June):830–1.
Saahil Mehta*
Simon Booth
Baljit Dheansa
The Burns Centre, Queen Victoria Hospital,
East Grinstead RH17 3DZ, United Kingdom
*Corresponding author
E-mail address: [email protected] (S. Mehta)
Accepted 19 August 2013
0305-4179/$36.00.
# 2013 Published by Elsevier Ltd and ISBI.
http://dx.doi.org/10.1016/j.burns.2013.08.015
Letter to the Editor
The determination of total burnsurface area
We read with interest a recently published article entitled
‘‘The determination of total burn surface area: how much
quality of burn assessments.
Though the authors have presented a general comparison
of common methods with computer-aided model, it would be
interesting to note the variations between these common
methods to know if any of these methods overestimated the
burn surface area in particular. Were there differences in esti-
mation of burn surface area among participants who selected
only single method vs. those who selected at least two different
methods of TBSA determination? The present correspondence is
intended to seek this additional information that would be useful
in indicating the extent of overestimation of total burn surface
area using the three techniques individually, and to make choices
among the common methods for a more appropriate one.
Conflict of interest
None declared.
r e f e r e n c e
[1] Giretzlehner M, Dirnberger J, Owen R, Haller HL, LumentaDB, Kamolz LP. The determination of total burn surface area:how much difference. Burns 2013;39:1107–13.
Tanuj Kanchan*
Department of Forensic Medicine and Toxicology,
Kasturba Medical College (Affiliated to Manipal University),
Mangalore, India
*Tel.: +91 824 2444590x5565; fax: +91 824 2428183;
mobile: +91 9448252394
E-mail addresses: [email protected]
[email protected] (T. Kanchan)
0305-4179/$36.00.
# 2013 Elsevier Ltd and ISBI. All rights reserved.
http://dx.doi.org/10.1016/j.burns.2013.07.018
Letter to the Editor
The determination of total burnsurface area: How big is the difference?
Thank you for your comment and feedback. You enquired
about variations among the commonly used methods and if