Amputations and Artificial Limbs--Symposium: Limb Salvage Versus Amputation
Preliminary Results of the Mangled Extremity Severity Score. Helfet, D L. Howey, T. Sanders, R. Johansen, K. Clinical Orthopaedics & Related Research. 1990 Jul. 256. pp 80-86. Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p < 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p < 0.01). In both the prospective and retrospective studies, a MESS score of >=7 had a 100 per cent predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation. salvage success or failure. By analyzing these clinical categories with a numerical rating scale, the authors have found a 100 per cent rate of sensitivity and specificity in predicting the outcome of an injured limb. For both the retrospective and the prospective study, statistically significant differences were found between the mean scores of salvaged limbs and limbs ultimately requiring amputation. Furthermore, all the salvaged limbs had scores of 6 or lower, and all patients whose limbs required amputation had scores of 7 or higher. In other words, a score of 7 or higher had a positive predictive value of 100 per cent for amputation. Even though the preliminary results of this study appear very promising, it still pertains to a relatively small data base and lacks follow-up information about the long-term functional outcome of the salvaged limbs. As yet (after one and one-half years of follow-up study), no salvaged limb has had a subsequent delayed
Original Text by Clifford R. Wheeless, III, MD.
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