Automated computer-assisted surface area estimation in large surface burns: Is Fiji taking over burn care?

Aims: Although several methods exist for estimating the extent of large surface burns, common approaches often tend toward overestimation and have notable limitations. This study was performed to assess the accuracy of Fiji software for manual and automated computer-assisted estimation of large surface burns. Methods: A retrospective analysis of the burn registry of a European Burns Association certified burn center was performed from January 1, 2019 to October 1, 2024. Fiji was used for manual and computer-assisted total body surface area (TBSA) estimation from admission photographs of patients with large surface burns. The results were compared with TBSA estimations made using a smartphone application, the referring emergency doctor, and a consultant plastic surgeon. Results: In total, 37 patients were included. Excellent intra-examiner agreement was found between the estimations made by the consultant plastic surgeon and automated Fiji estimations (0.968), followed by manual Fiji estimations (0.958). Similar results were obtained between automated and manual computer-assisted TBSA estimations using Fiji (0.991), with a mean deviation of 0.729%. The mean deviation between automated computer-assisted TBSA estimations using Fiji and the consultant plastic surgeon was -4.189%. Conclusions: Manual and automated computer-assisted TBSA estimations using Fiji provided highly accurate results via pixel-by-pixel analysis, demonstrating that automated methods can match the precision of manual approaches. These findings highlight the expanding role of computer-assisted image analysis in improving burn care practices.