Variability of Characterization of Total Body Surface Area in Burn Outcomes: A Burn Model System Study

Total body surface area (TBSA) burned is critical for assessing burn extent and guiding acute treatment, but its role in predicting long-term outcomes remains underexplored. This study leverages the Burn Model Systems (BMS) database to evaluate how TBSA is characterized and its predictive value for survivors' outcomes, aiming to propose standardized approaches for its use. Publications from the BMS database (1994-2024) were analyzed for TBSA characterization and its relationship to both patient-reported outcomes (eg, quality of life, psychological well-being) and objective outcomes (eg, physical recovery, complications). Descriptive statistics were used to summarize TBSA usage across studies and its influence on outcomes. Of 107 publications, 91 (85%) included TBSA data. Among these, 91% used TBSA as a continuous variable, 23% employed categorical methods, and 16% utilized both. Categorical TBSA stratification varied, with deciles (n = 6) and quintiles (n = 3) being most common, while others used inconsistent approaches. Approximately 32% of studies assessed TBSA's direct impact on outcomes such as physical and psychosocial recovery, return to work, and pain/itch. A quarter of studies included TBSA as a covariate without directly examining its predictive value. Of 32 papers reporting TBSA outcomes, 74.4% demonstrated significant impact on outcomes. TBSA is widely utilized but inconsistently characterized, and few studies directly assess its role in long-term outcomes. Standardizing TBSA reporting could improve predictive accuracy, facilitate cross-study comparisons, and guide evidence-based care for burn survivors.