Comparison of three techniques using the Parkland Formula to aid fluid resuscitation in adult burns

We performed a randomised study to compare the accuracy and speed of three different techniques (pen and paper, electronic calculator and a novel graphic device: 'nomogram') for calculation of resuscitation fluid requirements for adults in the first 24 h of burn injury, based on the Parkland Formula. We also assessed acceptability of each technique using visual analogue scores and qualitative analysis of free text responses. 28 participants performed 252 calculations using a series of computer generated simulated patient data. For nomogram, electronic calculator, pen and paper: Magnitude of error [low (≥25%), medium (≥50%), high (≥75%)]: [6.0%, 1.2%, 0%], [17.9%, 14.3%, 8.3%], [25%, 16.7%, 9.5%]; p<0.002. Calculation time: [sec: mean (SD)]: 94(34), 73(31), 214(103); p<0.001. The mean (SD) of the difficulty scores for each method were 23(17), 17(14) and 70(21) out of 100. Of the 28 participants 15 preferred the calculator, 12 preferred the nomogram and 1 scored the calculator and nomogram equally (table 3). The nomogram was significantly more accurate at all levels, almost as fast as an electronic calculator, and deemed easy to use. It is low cost and robust, and provides a rapid means of detecting and preventing the large errors that we have shown can occur when an electronic device is used as the only method of calculation. We therefore suggest that the Parkland Formula nomogram is a suitable method for calculation of resuscitation fluid requirements in adult burns. Fluid requirement should, however, be reviewed frequently, and adjusted to ensure adequate organ perfusion.