Small Burns Need Attention Too - Evaluating the 15% Burn Resuscitation Threshold in Adults

Q: How did the study classify fluid resuscitation and urine output?

Fluid resuscitation was categorized by Parkland formula as “below range” (PF 5). Urine output was categorized as “below range” ( 50 mL/h).

Sep 29, 2026

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The American Burn Life Support course recommends fluid resuscitation for patients with TBSA ≥20% to prevent burn shock, yet one center resuscitates patients above 15% TBSA. This retrospective study reviewed protocolized fluid resuscitation for burns 15% to 19.9% TBSA admitted from 2019-01-01 to 2023-03-31, comparing Parkland formula categories (“below,” “within,” “above” range) and urine output ranges. No demographic, injury, or complication differences emerged. Average creatinine and lactate at 24 hours were 0.9 mg/dL and 2 mg/dL, while about 20% required vasopressors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Introduction

Burn resuscitation background and Parkland formula

Evidence gap for burns under 20% TBSA

ORIGINAL ARTICLE Small Burns Need Attention Too: Evaluating the 15% Burn Resuscitation Threshold in Adults Ashleigh Bull, MD1 , 2 ; Mala Sharma, MD1 , 2 ; Alexander Kurjatko, MD, MPH1 , 2 , * ; Sarah Wellsandt, RN1 , 2 ; Brooke Dwars, MBA1 , 2 ; Colette Galet, PhD1 , 2 ; Lucy Wibbenmeyer, MD1 , 2 Abstract The American Burn Life Support course recommends ﬂuid resuscitation of patients with TBSA ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15% to 19.9% TBSA admitted from January 1, 2019 to March 31, 2023 who received protocolized ﬂuid resuscitation were included. Demographics, hospital course, and ﬂuids received were reviewed. Fluid resuscitation was categorized as “below range”(Parkland formula [PF] < 3 mL/kg/%TBSA),“within range”(PF=3-5 mL/kg/%TBSA or “above range”(PF> 5 mL/kg/%TBSA) . Similarly, urine output (UOP) was expressed as “below range”( <30 mL/h),“within range”(31-50 mL/h) or “above range”(>50 mL/h) . The resuscitation groups were compared. P < .05 was considered signiﬁcant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%) . Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h postadmission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may beneﬁt from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study. Key words: burn injury; resuscitation; over resuscitation; resuscitation protocols; vasopressors; albumin; colloid. 1 Department of Surgery, University of Iowa, Iowa Health Care, Iowa City, IA 52246, USA; 2 Department of Nursing, University of Iowa, Iowa Health Care, Iowa City, IA 52246, USA Author contributions: Ashleigh Bull (Conceptualization, Data curation, Formal analysis, Writing—original draft, Writing—review & editing: [equal]), Mala Sharma (Conceptualization [supporting], Data curation [equal], Formal analysis [supporting], Writing—original draft, Writing—review & editing [equal]), Alexander Kurjatko (Conceptualization, Data curation [equal], Formal analysis [supporting], Writing—original draft, Writing—review & editing [equal]), Sarah Wellsandt (Conceptualization [equal], Formal analysis, Writing—original draft [supporting], Writing—review & editing [equal]), Brooke Dwars (Conceptualization [equal], Writing—original draft [supporting], Writing—review & editing [equal]), Colette Galet (Conceptualization [equal], Data curation[supporting], Formal analysis, Methodology [lead], Writing—original draft, Writing—review & editing [equal]), and Lucy Wibbenmeyer (Conceptualization [lead], Data curation [supporting], Project administration [lead], Writing—original draft [equal], Writing—review & editing [equal]) Funding: None declared. Conﬂict of interest statement: A.K.: Vericel (consulting), Direct Biologics (research); L. W.: Vericel, Polynovo (consulting); Spectral MD, Polynovo, Skingenix (research); Paradigm Insurance (employment) . *Address correspondence to A.K. ([email:](email: alexander-kurjatko@uiowa.edu)[ alexander-kurjatko@uiowa.edu](email: alexander-kurjatko@uiowa.edu)) © The Author(s) 2025 . Published by Oxford University Press on behalf of the American Burn Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( [https://](https://)[ ](https://)[creativecommons. org/licens

FAQs

What patient group and time period were included in this study?

Patients with burns 15% to 19.9% TBSA admitted from January 1, 2019 to March 31, 2023 who received protocolized fluid resuscitation were included.

How did the study classify fluid resuscitation and urine output?

Fluid resuscitation was categorized by Parkland formula as “below range” (PF < 3 mL/kg/%TBSA), “within range” (PF 3–5), and “above range” (PF > 5). Urine output was categorized as “below range” (<30 mL/h), “within range” (31–50 mL/h), and “above range” (>50 mL/h).

What were the main findings regarding outcomes between resuscitation groups?

No differences were found between groups regarding demographics, burn injury variables, or complications. Half of patients received more than maintenance, and average creatinine and lactate at 24 hours were 0.9 mg/dL and 2 mg/dL, respectively.

Sep 29, 2026

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