Valutazione della superfice corporea ustionata (TBSA) e la rianimazione con fluidi in ambito extraospedaliero: una revisione narrativa della letteratura [Total Body Surface Area (TBSA) burned assessment and fluid therapy in prehospital emergency setting: a narrative review of literature]

Introduction: Accurate estimation of burn size is of paramount importance in the out-of-hospital setting to calculate fluid requirements for infusion and to avoid complications by improving clinical outcomes for patients. Fluid resuscitation is one of the priority interventions in the early management of patients with extensive burns and, in the literature, there are several formulas for determining fluid requirements that also consider the percentage of total body surface area burned (TBSA). Materials and methods: The objective of this work is to understand the level of accuracy of methods for assessing % TBSA burns in the out-of-hospital setting, and how much this aspect affects the correct calculation of fluids to be infused into the burn patient. For this purpose, a literature review was conducted by consulting the MEDLINE, PubMed interface, CINAHL, SCOPUS, and Google Scholar databases. Results: All studies included in the review emphasize the importance of correct assessment of % TBSA because, inaccurate estimation of burn size occurs frequently in clinical practice, with important consequences for both patients. Discussion: The most frequently reported error is the overestimation of burn size, which tends to be more significant in small burns. The review shows that new techniques and methods are needed to help healthcare personnel in improving TBSA estimates. For example, clinical aids, computer-assisted methods, or smartphone applications are suggested. Conclusions: The accuracy of early measurement affects all subsequent choices, from fluid management to management regarding transport and hospitalization. Keywords: Burns, Body Surface Area, Fluid Therapy, Emergency Medical Services.