Which is a severe burn in a 65-year-old patient?

• A. Superficial burn to 30% of the BSA
• B. Full-thickness burn to 1% of the BSA
• C. Partial-thickness burn to 20% of the BSA
• D. Second-degree burn covering 10% of the BSA

Answer: (C)

Depth and extent determine how serious a burn is, and age adds risk because healing is slower and complications are more likely in older adults. A burn that involves the dermal layer (partial-thickness) and covers a large area poses the greatest challenge: it bleeds more fluid, swells more, is more painful, and has a higher risk of infection and prolonged healing. When this dermal involvement spans about 20% of the body, the injury is substantial enough to be considered severe in a 65-year-old.

In contrast, a superficial burn that covers 30% of the body involves only the outermost layer of skin and, while large, usually heals readily with wound care and carries less risk of complications. A small full-thickness burn, though deep, affects only a tiny area, so the overall burden is less than a larger partial-thickness burn. A second-degree burn over 10% of the body is significant but still less extensive than 20% with dermal involvement, especially given the patient’s age.

So, the burn described as partial-thickness and involving 20% of the body surface area represents the most severe combination of depth and extent for a 65-year-old.