- from Johansen et.al. 1990)
Skeletal / soft-tissue injury
Low energy (stab; simple fracture; pistol gunshot wound) 1
Medium energy (open or multiple fractures, dislocation) 2
High energy (high speed MVA or rifle GSW) 3
Very high energy (high speed trauma + gross contamination) 4
Limb ischemia
Pulse reduced or absent but perfusion normal 1*
Pulseless; paresthesias, diminished capillary refill 2
Cool, paralyzed, insensate, numb 3*
Shock
Systolic BP always > 90 mm Hg 0
Hypotensive transiently 1
Persistent hypotension 2
Age (years)
< 30 0
30-50 1
> 50 2
* Score doubled for ischemia > 6 hours
- Discussion:
- in the report by Bosse et al (JBJS 2001), the authors studied the clinical utility of five lower
extremity injury-severity scoring systems;
- 546 high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity
scoring systems for lower-extremity trauma designed to assist in the decision-making process for
the care of patients with such injuries;
- 407 limbs remained in the salvage pathway six months after the injury;
- the analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores;
- high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential;
- the converse was not true - low sensitivity of the indices failed to support the validity of the scores as predictors of amputation.
- see
tibial defect reconstruction and
amputation following tibia fractures
Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.
Amputations and Artificial Limbs--Symposium: Limb Salvage Versus Amputation: Preliminary Results of the Mangled Extremity Severity Score.
A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores
Michael J. Bosse, MD et al. (J Bone Joint Surg [Am] 83-A: 3-14, 2001)
To Reconstruct or Not to Reconstruct?
An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.
