{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:39:54Z","timestamp":1755225594450,"version":"3.43.0"},"reference-count":52,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2016,3,3]]},"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>While the epidemiology of amputations in patients with burns has been investigated previously, the effect of an amputation on burn size and its impact on fluid management have not been considered in the literature. Fluid resuscitation volumes are based on the percentage of the total body surface area (%TBSA) burned calculated during the primary survey. There is currently no consensus as to whether the fluid volumes should be recalculated after an amputation to compensate for the new body surface area. The aim of this study was to model the impact of an amputation on burn size and predicted fluid requirement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective search was performed of the database at the Queen Elizabeth Hospital Birmingham Regional Burns Centre to identify all patients who had required an early amputation as a result of their burn injury. The search identified 10 patients over a 3-year period. Burn injuries were then mapped using 3D modelling software. BurnCase3D is a computer program that allows accurate plotting of burn injuries on a digital mannequin adjusted for height and weight. Theoretical fluid requirements were then calculated using the Parkland formula for the first 24\u2005h, and Herndon formula for the second 24\u2005h, taking into consideration the effects of the amputation on residual burn size.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results and conclusions<\/jats:title>\n                  <jats:p>This study demonstrated that amputation can have an unpredictable effect on burn size that results in a significant deviation from predicted fluid resuscitation volumes. This discrepancy in fluid estimation may cause iatrogenic complications due to over-resuscitation in burn-injured casualties. Combining a more accurate estimation of postamputation burn size with goal-directed fluid therapy during the resuscitation phase should enable burn care teams to optimise patient outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2015-000438","type":"journal-article","created":{"date-parts":[[2016,6,8]],"date-time":"2016-06-08T23:58:57Z","timestamp":1465430337000},"page":"58-64","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Should early amputation impact initial fluid therapy algorithms in burns resuscitation? A retrospective analysis using 3D modelling"],"prefix":"10.1136","volume":"163","author":[{"given":"Robert M T","family":"Staruch","sequence":"first","affiliation":[{"name":"School of Engineering & Applied Sciences, Harvard University, USA"},{"name":"Department of Burns and Plastic Surgery, St Marys Hospital, Imperial College Healthcare, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Beverly","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics, Royal Surrey County Hospital, Guildford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Burns & Plastic Surgery, St Andrews Centre for Burns & Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,6,8]]},"reference":[{"key":"2025081308130315000_163.1.58.1","doi-asserted-by":"crossref","unstructured":"Mlcak RP , Buffalo MC , Jimenez CJ . Chapter 7\u2014pre-hospital management, transportation and emergency care. In: Herndon DN , edr. Total burn care. 4th edn. London: W.B. Saunders, 2012:93\u2013102.e1.","DOI":"10.1016\/B978-1-4377-2786-9.00007-2"},{"key":"2025081308130315000_163.1.58.2","doi-asserted-by":"crossref","unstructured":"Kramer GC . Chapter 8\u2014pathophysiology of burn shock and burn edema. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:103\u201313.e4.","DOI":"10.1016\/B978-1-4377-2786-9.00008-4"},{"key":"2025081308130315000_163.1.58.3","doi-asserted-by":"crossref","unstructured":"Warden GD . Chapter 9\u2014fluid resuscitation and early management. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:115\u201324.e3.","DOI":"10.1016\/B978-1-4377-2786-9.00009-6"},{"key":"2025081308130315000_163.1.58.4","doi-asserted-by":"crossref","unstructured":"Lewis GM , Heimbach DM , Gibran NS . Chapter 10\u2014evaluation of the burn wound: management decisions. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:125\u201330.e2.","DOI":"10.1016\/B978-1-4377-2786-9.00010-2"},{"key":"2025081308130315000_163.1.58.5","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/00005373-199809000-00017","article-title":"Factors contributing to delayed extremity amputation in burn patients","volume":"45","author":"Yowler","year":"1998","journal-title":"J Trauma"},{"key":"2025081308130315000_163.1.58.6","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(86)90253-9"},{"key":"2025081308130315000_163.1.58.7","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/0305-4179(95)00036-B","article-title":"Outcome of amputations in patients with major burns","volume":"21","author":"Viscardi","year":"1995","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.8","doi-asserted-by":"publisher","DOI":"10.1097\/01.BCR.0000203492.89591.A1"},{"key":"2025081308130315000_163.1.58.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0305-4179(97)00081-8"},{"key":"2025081308130315000_163.1.58.10","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.burns.2013.07.021","article-title":"Burn surface area calculation: what do we need in future","volume":"40","author":"Kamolz","year":"2014","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.11","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.burns.2013.05.009","article-title":"Lack of precision of burn surface area calculation by UK Armed Forces medical personnel","volume":"40","author":"Martin","year":"2014","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.12","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181ac68cf"},{"key":"2025081308130315000_163.1.58.13","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000559"},{"key":"2025081308130315000_163.1.58.14","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.burns.2013.05.016","article-title":"A novel means to classify response to resuscitation in the severely burned: derivation of the KMAC value","volume":"39","author":"Kelly","year":"2013","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.15","first-page":"Doc14","article-title":"Fluid resuscitation protocols for burn patients at intensive care units of the United Kingdom and Ireland","volume":"9","author":"Al-Benna","year":"2011","journal-title":"Ger Med Sci"},{"key":"2025081308130315000_163.1.58.16","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s00101-011-1849-4","article-title":"[Estimation of substitution volume after burn trauma. Systematic review of published formulae]","volume":"60","author":"Spelten","year":"2011","journal-title":"Anaesthesist"},{"key":"2025081308130315000_163.1.58.17","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2008.058123"},{"key":"2025081308130315000_163.1.58.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.burns.2008.01.011"},{"key":"2025081308130315000_163.1.58.19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0169-2607(95)01637-9","article-title":"A model of fluid resuscitation following burn injury: formulation and parameter estimation","volume":"47","author":"Ampratwum","year":"1995","journal-title":"Comput Methods Programs Biomed"},{"key":"2025081308130315000_163.1.58.20","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/S0305-4179(00)00145-5","article-title":"The influence of body mass index on burn surface area estimated from the area of the hand","volume":"27","author":"Berry","year":"2001","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.21","first-page":"352","article-title":"The estimation of areas of burn","volume":"79","author":"Lund","year":"1944","journal-title":"Surg Gynecol Obstet"},{"key":"2025081308130315000_163.1.58.22","doi-asserted-by":"crossref","first-page":"e29","DOI":"10.1097\/BCR.0b013e3182676e07","article-title":"Comparison of traditional burn wound mapping with a computerized program","volume":"34","author":"Williams","year":"2013","journal-title":"J Burn Care Res"},{"key":"2025081308130315000_163.1.58.23","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.burns.2013.01.021","article-title":"The determination of total burn surface area: how much difference?","volume":"39","author":"Giretzlehner","year":"2013","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.24","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.burns.2008.07.010","article-title":"\u201cUnderstanding burns\": research project BurnCase 3D\u2014overcome the limits of existing methods in burns documentation","volume":"35","author":"Haller","year":"2009","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.25","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31821cb790"},{"key":"2025081308130315000_163.1.58.26","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/BCR.0b013e318217f8c6","article-title":"A new method for estimation of involved BSAs for obese and normal-weight patients with burn injury","volume":"32","author":"Neaman","year":"2011","journal-title":"J Burn Care Res"},{"key":"2025081308130315000_163.1.58.27","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1177\/000313481107700818","article-title":"Obesity in trauma patients: correlations of body mass index with outcomes, injury patterns, and complications","volume":"77","author":"Evans","year":"2011","journal-title":"Am Surg"},{"key":"2025081308130315000_163.1.58.28","doi-asserted-by":"publisher","DOI":"10.1097\/BCR.0000000000000190"},{"key":"2025081308130315000_163.1.58.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0305-4179(00)00128-5"},{"key":"2025081308130315000_163.1.58.30","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/S0305-4179(98)00161-2","article-title":"Evolution of the Emergency Management of Severe Burns (EMSB) course in the UK","volume":"25","author":"Stone","year":"1999","journal-title":"Burns"},{"key":"2025081308130315000_163.1.58.31","unstructured":"Australian, Committee NZBAE. Emergency Management of Severe Burns (EMSB): Course Manual. Australian and New Zealand Burn Association, 2006."},{"key":"2025081308130315000_163.1.58.32","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000219645.88867.b7"},{"key":"2025081308130315000_163.1.58.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1968.tb14738.x"},{"key":"2025081308130315000_163.1.58.34","doi-asserted-by":"crossref","unstructured":"Rosenberg L . Chapter 11\u2014enzymatic debridement of burn wounds. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:131\u20135.e1.","DOI":"10.1016\/B978-1-4377-2786-9.00011-4"},{"key":"2025081308130315000_163.1.58.35","doi-asserted-by":"crossref","unstructured":"Gallagher JJ , Branski LK , Williams-Bouyer N , et al . Chapter 12\u2014treatment of infection in burns. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:137\u201356.e2.","DOI":"10.1016\/B978-1-4377-2786-9.00012-6"},{"key":"2025081308130315000_163.1.58.36","doi-asserted-by":"crossref","unstructured":"Lee JO , Dibildox M , Jimenez CJ , et al . Chapter 13\u2014operative wound management. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:157\u201372.e2.","DOI":"10.1016\/B978-1-4377-2786-9.00013-8"},{"key":"2025081308130315000_163.1.58.37","doi-asserted-by":"publisher","DOI":"10.1097\/01.BCR.0000155540.31879.FB"},{"key":"2025081308130315000_163.1.58.38","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/01.BCR.0000235466.57137.f2","article-title":"Evolution of burn resuscitation in operation Iraqi freedom","volume":"27","author":"Chung","year":"2006","journal-title":"J Burn Care Res"},{"key":"2025081308130315000_163.1.58.39","unstructured":"The Emergency Management of Severe Burns. Course Manual. The British Burns Association, 2015."},{"key":"2025081308130315000_163.1.58.40","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/BCR.0000000000000037","article-title":"A mobile app for measuring the surface area of a burn in three dimensions: comparison to the Lund and Browder assessment","volume":"35","author":"Goldberg","year":"2014","journal-title":"J Burn Care Res"},{"key":"2025081308130315000_163.1.58.41","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1177\/000313481508100131","article-title":"Total body surface area overestimation at referring institutions in children transferred to a burn center","volume":"81","author":"Swords","year":"2015","journal-title":"Am Surg"},{"key":"2025081308130315000_163.1.58.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2005.04.007"},{"key":"2025081308130315000_163.1.58.43","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181e425f1"},{"key":"2025081308130315000_163.1.58.44","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4103\/0974-2700.76845","article-title":"A primer on burn resuscitation","volume":"4","author":"Bacomo","year":"2011","journal-title":"J Emerg Trauma Shock"},{"key":"2025081308130315000_163.1.58.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.burns.2008.09.007"},{"key":"2025081308130315000_163.1.58.46","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/BCR.0000000000000178","article-title":"A Noninvasive computational method for fluid resuscitation monitoring in pediatric burns: a preliminary report","volume":"36","author":"Stewart","year":"2015","journal-title":"J Burn Care Res"},{"key":"2025081308130315000_163.1.58.47","doi-asserted-by":"crossref","unstructured":"Lundy JB , Chung KK , Pamplin JC , et al . Update on Severe Burn Management for the Intensivist. J Intensive Care Med 2015. doi:10.1177\/0885066615592346","DOI":"10.1177\/0885066615592346"},{"key":"2025081308130315000_163.1.58.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2008.02.003"},{"key":"2025081308130315000_163.1.58.49","unstructured":"Cubano MA . Emergency War Surgery. 4th edn. Borden Institute, Office of the Surgeon General, 2011."},{"key":"2025081308130315000_163.1.58.50","unstructured":"Renz EM , Cancio EC . Acute Burn Care. Chapter 12. Combat Casualty Care Book, Borden Institute, Office of the Surgeon General."},{"key":"2025081308130315000_163.1.58.51","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/BCR.0b013e31815f5a62","article-title":"The Parkland formula under fire: is the criticism justified?","volume":"29","author":"Blumetti","year":"2008","journal-title":"J Burn Care Res"},{"key":"2025081308130315000_163.1.58.52","doi-asserted-by":"crossref","unstructured":"Branski LK , Herndon DN , Barrow RE . Chapter 1\u2014a brief history of acute burn care management. In: Herndon DN , ed. Total burn care. 4th edn. London: W.B. Saunders, 2012:1\u20137.e2.","DOI":"10.1016\/B978-1-4377-2786-9.00001-1"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2015-000438","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T15:13:13Z","timestamp":1755097993000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2015-000438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,8]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,1,27]]},"published-print":{"date-parts":[[2017,2]]}},"alternative-id":["10.1136\/jramc-2015-000438"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2015-000438","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"type":"print","value":"0035-8665"},{"type":"electronic","value":"2052-0468"}],"subject":[],"published":{"date-parts":[[2016,6,8]]}}}