Burn Injury Assessment
First aid: remove clothing and jewellery; cool running water for 20 min, up to 3 h after the burn. Dry chemical powder (for example lime): brush off first, then irrigate. Keep the patient warm. Depth evolves over 48-72 h.
All Pathways
Plastic SurgeryDiagnostic
Burn Depth Assessment Algorithm
Burn Depth Assessment Algorithm: Burn Injury Assessment → Check burn service referral criteria first → Assess depth: colour, blisters, capillary refill,...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Warning Check burn service referral criteria first
Estimate % TBSA with the patient's palm and fingers (about 1%) or a Lund and Browder chart (paediatric chart for children); do not count epidermal burns. Refer if: >10% TBSA (child >5%); full thickness >5%; face, hands, feet, genitalia, perineum or major joints; circumferential; inhalation; electrical; chemical, lime or thermoplastic; major trauma; pregnancy; young child or elderly; pre-existing illness; non-accidental burn.
- Major burn or inhalation injury: primary survey and resuscitation first (EMSB), then transfer
- Electrical or chemical burn: deep damage can lie under intact-looking skin. Electrical: ECG. Chemical: brush off powder, then irrigate; Poisons 13 11 26
- Child: if the history does not match the injury, consider non-accidental injury and involve child protection
03Decision Assess depth: colour, blisters, capillary refill, sensation
Classify by the deepest area. If depth is unclear or mixed, discuss with the burn service and reassess at 24-48 h.
- Red, no blisters
04Action Epidermal (superficial, 1st degree)
Red, skin intact, no blisters, brisk capillary refill, painful
- Heals by itself in 3-7 days
- Do not count in % TBSA
05End Epidermal: moisturiser and analgesia
No dressing needed. Follow-up usually not needed. Review if blisters appear, because depth can progress.
- Pale pink, brisk refill
06Action Superficial dermal (superficial partial thickness, 2nd degree)
Pale pink, blisters present or absent, brisk capillary refill, painful
- Should heal within 7-10 days
07Action Superficial or mid dermal: clean, debride, dress
Analgesia. Tetanus prophylaxis if due (burns are tetanus-prone).
- Clean with 0.1% aqueous chlorhexidine or 0.9% saline (saline if chlorhexidine allergy)
- Remove loose non-viable skin; debride blisters >5 cm or over joints
- Superficial dermal: paraffin gauze or silicone (silver if contaminated). Mid dermal: silver or silicone
- Absorbent secondary dressing: exudate is high in the first 72 h
08End Dermal burn: review in 24-48 h
Reassess depth at each dressing change. Refer to the burn service if deeper than first thought, infected, or not healed by 14 days. Child who becomes unwell (fever, rash, vomiting or diarrhoea, lethargy): same-day medical review for possible toxic shock syndrome, even if the wound looks clean.
- Dark pink, sluggish refill
09Action Mid dermal (partial thickness, 2nd degree)
Dark pink to red, blisters, sluggish capillary refill, sensation may be reduced
- Should heal within 14 days
- Deeper areas may need grafting: discuss early with the burn service
- Path rejoins step 07Shared downstream outcome
- Blotchy red/white, absent refill
10Action Deep dermal (deep partial thickness, 2nd degree)
Blotchy red and white, very sluggish or absent capillary refill, sensation reduced or absent
- Generally needs surgery (excision and grafting)
11End Deep dermal or full thickness: refer to burn service
Likely excision and grafting. Silver (antimicrobial) dressing until review. Circumferential deep burn: check distal perfusion; escharotomy may be needed.
- White/waxy/leathery
12Action Full thickness (3rd degree)
White, waxy, brown, black or yellow; leathery; no capillary refill; no sensation
- Generally needs surgery (excision and grafting)
- Path rejoins step 11Shared downstream outcome
Guideline Source
ANZBA Initial Management of Minor Burns (poster v2) and ANZBA Burn Service Referral Criteria
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Depth evolves over 48-72 h and early assessment is often wrong: reassess at each dressing change
- Not for major burns, inhalation, electrical or chemical burns: use severe burn (EMSB) care and refer
- Depth is harder to judge in darker skin; rely on capillary refill and sensation
- Laser Doppler imaging, where available at a burn service, may help in burns of unclear depth
Contraindicated Populations
Major burns (>10% TBSA adult, >5% child) or inhalation injury: use severe burn (EMSB) managementElectrical, chemical, lime or thermoplastic burns: specific management and burn service referralSuspected non-accidental burn: child protection and burn service referral
Applicable Regions
AUNZUSUKEU
AU: ANZBA depth terms and referral criteria. Poisons Information Centre 13 11 26.
NZ: ANZBA referral criteria apply (National Burn Service). Poisons 0800 764 766.
UK: Refer using local burn network referral criteria.
US: ABA terms: superficial partial thickness = superficial dermal; deep partial thickness = deep dermal. Use ABA burn center referral criteria.
Version 2Next review: 2027-09-30
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Related Resources
Frequently Asked Questions
What is the Burn Depth Assessment Algorithm?
The Burn Depth Assessment Algorithm is a diagnostic clinical algorithm for Plastic Surgery. It provides a structured decision tree to guide clinical decision-making, based on ANZBA Initial Management of Minor Burns (poster v2) and ANZBA Burn Service Referral Criteria.
What guideline is the Burn Depth Assessment Algorithm based on?
This algorithm is based on ANZBA Initial Management of Minor Burns (poster v2) and ANZBA Burn Service Referral Criteria.
What are the limitations of the Burn Depth Assessment Algorithm?
Known limitations include: Depth evolves over 48-72 h and early assessment is often wrong: reassess at each dressing change; Not for major burns, inhalation, electrical or chemical burns: use severe burn (EMSB) care and refer; Depth is harder to judge in darker skin; rely on capillary refill and sensation; Laser Doppler imaging, where available at a burn service, may help in burns of unclear depth. Individual patient factors may require deviation from these recommendations.
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