Accuracy of Burn Size Estimation in Referred Patients: A Comparison Between Referring Units and a Swedish National Burn Centre

ABSTRACT Introduction Accurate estimation of burned total body surface area (TBSA%) is critical for fluid resuscitation, surgical planning, and referral decisions. International studies report frequent overestimation by non-experts, but Swedish data are lacking. Methods We conducted a cross-sectional study at Linköping Burn Centre, one of two national burn centres in Sweden. Between April 2024 and April 2025, real-time TBSA% estimates by referring physicians (non-experts) were compared with specialist assessments using the Lund & Browder chart. Bland–Altman plots and Wilcoxon signed-rank tests assessed agreement. Multiple linear regression identified predictors of discrepancy. Results Eighty-two patients were included (median age 33 years; 82% male). Non-experts overestimated TBSA% in 76% of cases. Median TBSA% was 10 [IQR 3.1 - 16.9] for non-experts versus 6 [IQR 1.5 - 12.8] for specialists (p < 0.001). Bland–Altman analysis demonstrated proportional bias, with discrepancies increasing with burn size. Multivariable linear regression was used to identify predictors of discrepancy. Predictors of discrepancy included >2 non-confluent burn spots (β = 2.525, p = 0.002), larger burns (β = 0.182, p < 0.001), male gender (β = 1.895, p = 0.043), and longer time between assessments (β = 0.268, p = 0.028). Presence of deep burns reduced discrepancy (β = –3.422, p < 0.001). Conclusion Non-experts frequently overestimate burn size, particularly for larger and anatomically complex burns. These findings highlight the need for improved precision in early burn assessment to better guide triage and resuscitation decisions.