Funding sources None.
The surface area of the hand and the palm for estimating percentage of total body surface area: results of a meta-analysis
Article first published online: 8 JUL 2013
© 2013 The Authors BJD © 2013 British Association of Dermatologists
British Journal of Dermatology
Volume 169, Issue 1, pages 76–84, July 2013
How to Cite
Rhodes, J., Clay, C. and Phillips, M. (2013), The surface area of the hand and the palm for estimating percentage of total body surface area: results of a meta-analysis. British Journal of Dermatology, 169: 76–84. doi: 10.1111/bjd.12290
Conflicts of interest None declared.
- Issue published online: 8 JUL 2013
- Article first published online: 8 JUL 2013
- Accepted manuscript online: 28 FEB 2013 11:24AM EST
- Manuscript Accepted: 24 FEB 2013
The estimation of body surface area involvement is an important tool. Hand surface area (HSA) or palm surface area (PSA) is commonly used for the estimate, with an assumption that HSA represents 1% of the total body surface area (TBSA).
To establish (i) the most accurate values for mean HSA% and PSA% of TBSA, and (ii) the variability of these with patient variables.
The PubMed, Embase and Cochrane databases were searched and 14 eligible studies were identified. Weighted means of HSA% and PSA% were produced. The meta-analysis examined systematic variation associated with sex, age (for children), body mass index (BMI) and ethnic group using random-effects models.
HSA% is 13% lower than the accepted 1% value for all adults (P = 0·004). PSA% is not significantly different from the accepted 0·5% value (P = 0·82). Men have a significantly higher HSA% than women (P < 0·0001). Children have a significantly higher HSA% than adults (P < 0·0001). HSA% falls with increasing BMI in adults (P < 0·0001). A comparison of European, Chinese and Indian subcontinent ethnic groups showed that each group was different from the others (P < 0·05).
The use of HSA equating to 1% TBSA results in an overestimate for adults (particularly women) and an underestimate for children. PSA equating to 0·5% TBSA appears to be suitable for adults. Patient variables including sex and BMI result in variation of HSA as a percentage of TBSA. The heterogeneity of the included studies and the lack of data for children are the major limitations of this study.