Simple Derivation of the Initial Fluid Rate for the Resuscitation of Severely Burned Adult Combat Casualties: In Silico Validation of the Rule of 10

In practice, current burn resuscitation formulas, designed to estimate 24-hour fluid resuscitation needs, provide only a starting point for resuscitation. To simplify this process, we devised the rule of 10 to derive the initial fluid rate. Methods We performed an in silico study to determine whether the rule of 10 would result in acceptable initial fluid rates for adult patients. A computer application using Java Sun Microsystems Inc., Santa Clara, CA generated a set of 100,000 random weights and percentage of total body surface area TBSA values with distributions matching the model characteristics with which the initial fluid rate was calculated using the rule of 10. The initial rate for 100,000 simulations was compared with initial rates calculated by using either the modified Brooke MB, 2 mLkgTBSA or the Parkland PL, 4 mLkgTBSA formulas. Results Analysis of calculated initial fluid rates using the rule of 10 showed that 87.8 n 87,840 of patients fell between the initial rates derived by the MB and the PL formulas. Less than 12 n 11,502 of patients had rule of 10 derived initial rates below the MB. Among these patients, the median difference of the initial rate was 14 mLhr range, 2 - 212 mLhr. Among those who had initial rule of 10 calculated rates greater than the PL formula less than 1, n 658, the median difference in rate was 33 mLhr range, 1 - 213 mLhr, with a mean TBSA of 21 1 and mean weight of 130 or - kg 11 kg. Conclusion For the majority of adult burn patients, the rule of 10 approximates the initial fluid rate within acceptable ranges.