Copyright © American Burn Association. Unauthorized reproduction of this article is prohibited. e546 Appropriate fluid resuscitation in severe burns, par- ticularly during the initial phase of injury, is one of the major determinants of survival. 1,2 It is known that children and adults are at risk of developing burn shock if the TBSA involvement is greater than 10%, and 15 to 20%, respectively. 3 Fluid resuscitation protocols introduced in the 1960s and 1970s played a major role in significantly reducing burns mortali- ties. 4 The Parkland Formula, devised originally by Baxter and Shires 5 to calculate fluid requirements in resuscitation burns, remains the most commonly applied formula in the United Kingdom and inter- nationally. 6–8 Over- or under-resuscitation in the acute phase following major burn injury can lead to significantly higher morbidities and mortalities. 9 There seems to be a tendency to overestimate burns, particularly larger ones in children. 10–12 Further- more, there are reports in the literature of inadver- tent over-resuscitation in overestimated patients. 13–15 The importance of optimal fluid resuscitation cannot Copyright © 2016 by the American Burn Association 1559-047X/2016 DOI: 10.1097/BCR.0000000000000382 Overestimation of burn size especially in children is common. It is unclear if this may cause harm. This study was designed to assess the accuracy of burn size estimation by referring non-burn clinicians and investigate whether inaccurate estimates caused any harm. Three and a half years retrospective review of pediatric resuscitation burns (ie, ≥10% TBSA) referred to a tertiary burns center from other hospitals was performed. This included basic demographics, data from referring emergency departments (initial TBSA estimations and fluid volumes prescribed), and data on arrival to the burn center (actual burn TBSA sustained, fluid volumes given prior to arrival, and actual fluid volumes required). Clinical parameters at 8 and 24 hr after injury were also examined. Forty-six patients were identified. Mean age was 3.9 years and weight 18 kg. Mean time to arrival from initial burn injury to our tertiary center was 5 hr. Thirty-two children (70%) had their burns overestimated, seven (15%) underestimated, and another seven (15%) were correctly estimated. After accurate calculations of the burn size and the required resuscitation fluids on arrival to the burns center, only five children of the entire cohort of 46 patients (11%) had received more fluids than required. These five children were in the overestimated burn size group. Only three children received the appropriate amount of fluid prior to arrival to the burns center. There were no mortalities or significant clinical adverse events in any of the children. Overestimation led to overprescription of fluid volumes, but this did not translate into over- resuscitation, and in most cases was in fact associated with inadequate fluid administration. Although 70% of the children in our cohort had the burn size overestimated, only 11% had actually received more fluids than required before arrival. None of these children went on to have any significant complications as a result of overestimation. Training and education is essential for clinicians in emergency departments. However, estimation of size in pediatric burns, in particular scalds, is challenging and the importance of early transfer to a specialist service cannot be overemphasized. (J Burn Care Res 2017;38:e546–e551) From the Healing Foundation Burns Research Centre, Birming- ham Children’s Hospital and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. This study was presented in poster format at the meeting of the American Burn Association in Boston, Massachusetts, March 2015. Address correspondence to Hazim Sadideen, BSc, MBBS, MEd, FRCS (Plast), Department of Burns, Plastic and Reconstructive Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, United Kingdom. Email: hazim.sadideen@doctors. org.uk. Does Overestimation of Burn Size in Children Requiring Fluid Resuscitation Cause Any Harm? Hazim Sadideen, FRCS (Plast), Federica D’Asta, MD, Naiem Moiemen, FRCS (Plast), Yvonne Wilson, FRCS (Plast) ORIGINAL ARTICLE