Concurrent Validity of Clinical Equations to Predict Resting Energy Expenditure Compared to Indirect Calorimetry in Non-Severe Burn Patients

Underfeeding and overfeeding can inhibit recovery and negatively impact quality of life during and after receiving treatment for a burn injury. Clinicians rely on accurate estimation of resting energy expenditure to avoid overfeeding or underfeeding their patients. The criterion standard for measuring resting energy expenditure is indirect calorimetry. Many burn services use predictive equations to prescribe feeding regimes because they are cheaper, time efficient and logistically more expedient than indirect calorimetry and do not require specialised equipment. However, the validity of these clinical equations has not been established in non-severe burns (15% total burn surface area, TBSA). In this study, resting energy expenditure was predicted for 35 participants with non-severe burn injuries using seven clinical equations and compared with the criterion-standard (indirect calorimetry). We found that all clinical equations may be inaccurate in predicting resting energy expenditure measured using indirect calorimetry, with the Schofield equation agreeing most closely (95% limits of agreement: -836 to 711 kcal.day-1). Agreement between clinical equations and indirect calorimetry remained poor even after correcting for TBSA. Our findings indicate clinical equations may not accurately predict resting energy expenditure of people who have sustained a non-severe burn. As such, we urge caution against relying solely on the existing predictive equations to guide clinical decisions regarding energy intake after non-severe burns.